Provider Demographics
NPI:1972826139
Name:MOIDUDDIN, SAMINA (LAC, DIPLAC)
Entity Type:Individual
Prefix:
First Name:SAMINA
Middle Name:
Last Name:MOIDUDDIN
Suffix:
Gender:F
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15315 KWANZAN CT
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4702
Mailing Address - Country:US
Mailing Address - Phone:240-506-4810
Mailing Address - Fax:
Practice Address - Street 1:15315 KWANZAN CT
Practice Address - Street 2:
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-4702
Practice Address - Country:US
Practice Address - Phone:240-506-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUO1674171100000X
DCAC500096171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist