Provider Demographics
NPI:1598819666
Name:CHIPPENDALE, MARION GWYNN (LAC)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:GWYNN
Last Name:CHIPPENDALE
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 1:727 SPOTTERS CT
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-3185
Mailing Address - Country:US
Mailing Address - Phone:410-374-0306
Mailing Address - Fax:
Practice Address - Street 1:8415 BELLONA LN
Practice Address - Street 2:SUITE 211
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2055
Practice Address - Country:US
Practice Address - Phone:410-382-2914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00904171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBM-78-MGOtherBCBS NON-PARTICIPATING P