ANCIENT WIDOM HEALING ARTS (NPI# 1114318094) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114318094 |
| Entity Type | Organization |
| Organization Name | ANCIENT WIDOM HEALING ARTS |
| Practice Address |
658 Kenilworth Dr Suite #102 Towson MD 21204-2312 |
| Mailing Address |
918 Wellington Rd Baltimore MD 21212-1921 |
| Practice Telephone | 4438383141 |
| Practice Fax Number | 4103776168 |
| Mailing Telephone | 4438383141 |
| Mailing Fax Number | 4103776168 |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2015-02-12 |
| Authorized Official Name | MR. STEVEN WILSON BROUSSARD (VICE PRESIDENT) |
| Authorized Official Telephone | 4438383141 |
| Authorized Official Credential | L. AC., M.T.O.M. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171100000X | Acupuncturist | LIC # U01120 | MD | Other Service Providers |
| Street Address |
658 KENILWORTH DR SUITE #102 |
| City | TOWSON |
| State | MD |
| Zip Code | 21204-2312 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518965185 | Audra Rachel Stern | Physical Therapist | 658 Kenilworth Dr, Suite 100, Towson, MD 21204-2312 | 2005-07-08 |
| 1952841678 | Leslie Wagner | Social Worker | 658 Kenilworth Dr, Suite 206, Towson, MD 21204-2312 | 2017-02-28 |
| 1528411725 | Quinton Myers Sr. | Nurse Practitioner | 658 Kenilworth Dr, Suite 206, Towson, MD 21204-2312 | 2016-07-22 |
| 1124418876 | Steven Wilson Broussard | Acupuncturist | 658 Kenilworth Dr, Towson, MD 21204-2312 | 2015-02-03 |
| 1548682305 | Sarah R Rixham | Physical Therapist | 658 Kenilworth Dr, Ste 100, Towson, MD 21204-2312 | 2014-01-14 |
| 1700208956 | Dental One Associates Kenilworth LLC | Dentist | 658 Kenilworth Dr, 210, Towson, MD 21204-2312 | 2014-01-07 |
| 1437499795 | Kristin Henry | Physical Therapist | 658 Kenilworth Dr, Suite 100, Towson, MD 21204-2312 | 2013-02-25 |
| 1508103862 | Life Fitness Physical Therapy LLC | Physical Therapist | 658 Kenilworth Dr, Suite 100, Towson, MD 21204-2312 | 2013-01-07 |
| 1982940565 | Carey Custer | Physical Therapy Assistant | 658 Kenilworth Dr, Suite 100, Towson, MD 21204-2312 | 2012-12-31 |
| 1750632022 | Stephanie Lynn Stover | Physical Therapist | 658 Kenilworth Dr, Ste 100, Towson, MD 21204-2312 | 2012-09-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194347575 | Sheppard Pratt Non Contracted Services, LLC | Psychiatry & Neurology | 6525 N. Charles Street, Gibson Building, Towson, MD 21204 | 2020-05-08 |
| 1578104428 | Debra James | Counselor | 6901 N. Charles Street, Towson, MD 21204 | 2019-10-02 |
| 1235696808 | Sarita Hinton | Social Worker | 300 Allegheny Ave Ste 101, Baltimore, MD 21204 | 2019-03-01 |
| 1952883159 | Peace,llc | Social Worker | 304 W. Chesapeake Ave, Towson, MD 21204 | 2018-09-04 |
| 1841772654 | Hannah Kimberly Jefferson | Acupuncturist | 7407 York Road, Towson, MD 21204 | 2018-08-29 |
| 1699255216 | Samantha Ann Rogers | Nurse Practitioner | 222 Bosley Avenue, Suite C3, Towson, MD 21204 | 2018-08-14 |
| 1750867560 | Angela Michelle Hester | Nurse Practitioner | 6525 N Charles St #085, Towson, MD 21204 | 2018-07-15 |
| 1043729098 | Communication Apptitude Inc. | Speech-Language Pathologist | 7400 York Road, Suite 231, Towson, MD 21204 | 2017-09-21 |
| 1679090203 | Brian Dougherty | Acupuncturist | 800 Kenilworth Dr, Ste# 828, Towson, MD 21204 | 2017-08-24 |
| 1659891976 | Erin Mcgovern | Specialist/Technologist | Towson Sports Medicine 8322 Bellona Ave, Suite Number 100, Baltimore, MD 21204 | 2017-06-27 |
| Find all providers in zip 21204 | ||||
| Taxonomy Code | 171100000X |
| Grouping | Other Service Providers |
| Classification | Acupuncturist |
| An acupuncturist is a person who performs ancient therapy for alleviation of pain, anesthesia and treatment of some diseases. Acupuncturists use long, fine needles inserted into specific points in order to treat painful conditions or produce anesthesia. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841772654 | Hannah Kimberly Jefferson | Acupuncturist | 7407 York Road, Towson, MD 21204 | 2018-08-29 |
| 1679090203 | Brian Dougherty | Acupuncturist | 800 Kenilworth Dr, Ste# 828, Towson, MD 21204 | 2017-08-24 |
| 1548719263 | Tbi Treatments LLC | Acupuncturist | 22 West Rd Ste 102, Towson, MD 21204-2388 | 2016-09-22 |
| 1659782159 | Hyeon-jin Kwon | Acupuncturist | 8415 Bellona Ln Ste 202, Towson, MD 21204 | 2014-05-19 |
| 1134541949 | Zhaobo Li | Acupuncturist | 200 E Joppa Rd # Siut108, Towson, MD 21286-3150 | 2014-01-13 |
| 1194093203 | Elisabeth Jane Stewart | Acupuncturist | 305 W Chesapeake Ave Ste 305, Towson, MD 21204-4440 | 2011-12-02 |
| 1184942914 | Faces Enterprises Towson Ltd | Acupuncturist | 894 Kenilworth Dr, 2nd Floor, Towson, MD 21204-2201 | 2010-05-04 |
| 1124269931 | Chris Scott Hammond | Acupuncturist | 8757 Mylander Lane, Towson, MD 21286 | 2009-03-09 |
| 1700091576 | Albert Liao | Acupuncturist | 7600 Osler Dr Ste 215, Towson, MD 21204-7701 | 2007-05-14 |
| 1922212687 | Cara Michele Nether | Acupuncturist | 1014 Dulaney Valley Rd, Towson, MD 21204-2702 | 2007-05-10 |
| Find all providers in TOWSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.