Provider Demographics
NPI:1891864633
Name:PHELPS, MARY ALICE (LIC ACUPUNCTURIST)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ALICE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:LIC ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5433
Mailing Address - Country:US
Mailing Address - Phone:410-828-6563
Mailing Address - Fax:
Practice Address - Street 1:658 KENILWORTH DR
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2312
Practice Address - Country:US
Practice Address - Phone:410-828-3585
Practice Address - Fax:410-828-8674
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00192171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist