Provider Demographics
NPI:1194093203
Name:STEWART, ELISABETH JANE (LAC)
Entity type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:JANE
Last Name:STEWART
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 1:305 W CHESAPEAKE AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4440
Mailing Address - Country:US
Mailing Address - Phone:410-296-1474
Mailing Address - Fax:
Practice Address - Street 1:305 W CHESAPEAKE AVE STE 305
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4440
Practice Address - Country:US
Practice Address - Phone:410-296-1474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00317171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist