Provider Demographics
NPI:1427351899
Name:EBAUGH, DANIEL IRVIN (MAC,LAC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:IRVIN
Last Name:EBAUGH
Suffix:
Gender:M
Credentials:MAC,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3930 KNOWLES AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2428
Mailing Address - Country:US
Mailing Address - Phone:301-949-5570
Mailing Address - Fax:
Practice Address - Street 1:3930 KNOWLES AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2428
Practice Address - Country:US
Practice Address - Phone:301-949-5570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00166171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU00166OtherSTATE OF MARYLAND, DEPARTMENT OF HEALTH AND MENTAL HYGIENE