Provider Demographics
NPI:1972895597
Name:DWYER, MARY BETH
Entity type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:DWYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY BETH
Other - Middle Name:
Other - Last Name:DWYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAC,LAC,
Mailing Address - Street 1:5710 NEWBURY ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3657
Mailing Address - Country:US
Mailing Address - Phone:301-351-3509
Mailing Address - Fax:
Practice Address - Street 1:5710 NEWBURY ST
Practice Address - Street 2:2ND FL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3657
Practice Address - Country:US
Practice Address - Phone:301-351-3509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUO1867171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist