Provider Demographics
NPI:1306132253
Name:ROSE, LAURA (M AC, L AC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:M AC, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8830 CAMERON ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8830 CAMERON ST
Practice Address - Street 2:SUITE 501
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4114
Practice Address - Country:US
Practice Address - Phone:216-906-5032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01913171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist