Provider Demographics
NPI:1841768405
Name:DAVIDOWITZ, LISA BELLE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BELLE
Last Name:DAVIDOWITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ISABELLE
Other - Middle Name:
Other - Last Name:DAVIDOWITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:6120 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-5806
Mailing Address - Country:US
Mailing Address - Phone:301-524-8441
Mailing Address - Fax:
Practice Address - Street 1:15 N COURT ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5413
Practice Address - Country:US
Practice Address - Phone:301-524-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02481171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist