Provider Demographics
NPI:1891936233
Name:BOBBI MEAD ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:BOBBI MEAD ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:301-695-9111
Mailing Address - Street 1:4920 JEFFERSON PIKE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-6912
Mailing Address - Country:US
Mailing Address - Phone:301-695-9111
Mailing Address - Fax:301-695-9115
Practice Address - Street 1:1560 OPOSSUMTOWN PIKE
Practice Address - Street 2:SUITE 25
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4748
Practice Address - Country:US
Practice Address - Phone:301-695-9111
Practice Address - Fax:301-695-9115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01482171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty