Provider Demographics
NPI:1992907877
Name:PELS, EDITH (LIC AC)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:PELS
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1502
Mailing Address - Street 2:1
Mailing Address - City:PROVINCETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02657-5502
Mailing Address - Country:US
Mailing Address - Phone:508-487-2400
Mailing Address - Fax:
Practice Address - Street 1:212 COMMERCIAL ST
Practice Address - Street 2:# 1
Practice Address - City:PROVINCETOWN
Practice Address - State:MA
Practice Address - Zip Code:02657-2134
Practice Address - Country:US
Practice Address - Phone:508-487-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213807171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist