Provider Demographics
NPI:1154518496
Name:PENNY S. TODD
Entity type:Organization
Organization Name:PENNY S. TODD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:MAC, LAC
Authorized Official - Phone:410-721-5742
Mailing Address - Street 1:2411 CROFTON LN
Mailing Address - Street 2:SUITE 17A
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1304
Mailing Address - Country:US
Mailing Address - Phone:410-721-5742
Mailing Address - Fax:410-982-6476
Practice Address - Street 1:2411 CROFTON LN
Practice Address - Street 2:SUITE 17A
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1304
Practice Address - Country:US
Practice Address - Phone:410-721-5742
Practice Address - Fax:410-982-6476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01046171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCH829001OtherFEDERAL BCBS
MD0W75PSOtherBCBS