Provider Demographics
NPI:1790050771
Name:PLOTKIN WALDER, DEVORAH JOY (LAC)
Entity Type:Individual
Prefix:MRS
First Name:DEVORAH
Middle Name:JOY
Last Name:PLOTKIN WALDER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:JOY
Other - Last Name:PLOTKIN WALDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10815 LOMBARDY RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1634
Mailing Address - Country:US
Mailing Address - Phone:301-802-7866
Mailing Address - Fax:
Practice Address - Street 1:8955 GUILFORD RD STE 240
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2651
Practice Address - Country:US
Practice Address - Phone:443-393-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01682171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist