Provider Demographics
NPI:1699166603
Name:WASSERMAN, MARC (PHD, LAC)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SHAWAN RD
Mailing Address - Street 2:SUITE 101-E
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1373
Mailing Address - Country:US
Mailing Address - Phone:410-709-8188
Mailing Address - Fax:
Practice Address - Street 1:5 SHAWAN RD
Practice Address - Street 2:SUITE 101-E
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21030-1373
Practice Address - Country:US
Practice Address - Phone:410-709-8188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02147171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist