Provider Demographics
NPI:1104080316
Name:MADERER, ANN M (LIC AC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:MADERER
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 PERRY ST
Mailing Address - Street 2:#1
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-4322
Mailing Address - Country:US
Mailing Address - Phone:781-856-4917
Mailing Address - Fax:
Practice Address - Street 1:CENTRAL SQUARE ACUPUNCTURE
Practice Address - Street 2:6 BIGELOW STREET
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139
Practice Address - Country:US
Practice Address - Phone:781-856-4917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA676171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist