Provider Demographics
NPI:1851410161
Name:SWEENEY, EDWARD JOSEPH III (LAC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOSEPH
Last Name:SWEENEY
Suffix:III
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 MONTPELIER RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-6010
Mailing Address - Country:US
Mailing Address - Phone:410-888-9048
Mailing Address - Fax:410-888-9004
Practice Address - Street 1:7750 MONTPELIER RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-6010
Practice Address - Country:US
Practice Address - Phone:410-888-9048
Practice Address - Fax:410-888-9004
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01256171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD621374-01OtherCAREFIRST NON-PAR PROV #