Provider Demographics
NPI:1790814721
Name:POLDMAE, SARA REICH (LAC)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:REICH
Last Name:POLDMAE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 OLD SOLOMONS ISLAND ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3872
Mailing Address - Country:US
Mailing Address - Phone:410-263-0411
Mailing Address - Fax:410-263-2290
Practice Address - Street 1:53 OLD SOLOMONS ISLAND ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3872
Practice Address - Country:US
Practice Address - Phone:410-263-0411
Practice Address - Fax:410-263-2290
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01390171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDAF63OtherBCBS