Provider Demographics
NPI:1750509204
Name:PEOPLES, MARLA ROSENTHAL (MAC, LAC)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:ROSENTHAL
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6628 CAMBRIA TER
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5952
Mailing Address - Country:US
Mailing Address - Phone:443-255-5024
Mailing Address - Fax:
Practice Address - Street 1:8450 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:SUITE 13
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3347
Practice Address - Country:US
Practice Address - Phone:410-465-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01488171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist