Provider Demographics
NPI:1790080661
Name:MARINAKIS, PETER (PHD, MAC, LAC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MARINAKIS
Suffix:
Gender:M
Credentials:PHD, MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2966 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-1306
Mailing Address - Country:US
Mailing Address - Phone:410-266-9370
Mailing Address - Fax:
Practice Address - Street 1:645 RIDGELY AVE
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1069
Practice Address - Country:US
Practice Address - Phone:410-266-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU-00190171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD341991177OtherTAX ID
MDU-00190OtherLICENSE NUMBER