Provider Demographics
NPI:1982194502
Name:MAREK, PETER (LAC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MAREK
Suffix:
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 1:80 TALLY HO CT
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-1759
Mailing Address - Country:US
Mailing Address - Phone:410-928-8058
Mailing Address - Fax:
Practice Address - Street 1:80 TALLY HO CT
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-1759
Practice Address - Country:US
Practice Address - Phone:410-928-8058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02478171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist