Provider Demographics
NPI:1396920815
Name:DAVIS, SUSAN (LAC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7106 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4565
Mailing Address - Country:US
Mailing Address - Phone:301-275-0165
Mailing Address - Fax:
Practice Address - Street 1:4600 CONNECTICUT AVE NW STE 223
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-5702
Practice Address - Country:US
Practice Address - Phone:202-244-8824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAC24171100000X
MDU284171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist