Provider Demographics
NPI:1982731097
Name:PERKINS, MARTIN EDWARD III (MAC, LAC)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:EDWARD
Last Name:PERKINS
Suffix:III
Gender:M
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18441 QUEEN ANNE RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8896
Mailing Address - Country:US
Mailing Address - Phone:410-507-1821
Mailing Address - Fax:
Practice Address - Street 1:18441 QUEEN ANNE RD
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8896
Practice Address - Country:US
Practice Address - Phone:410-507-1821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00764171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist