Provider Demographics
NPI:1528493129
Name:MOSHONISIOTIS, MARISSA JANISH (MAOM, LAC, CCH)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:JANISH
Last Name:MOSHONISIOTIS
Suffix:
Gender:F
Credentials:MAOM, LAC, CCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 FINSBURY RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4950
Mailing Address - Country:US
Mailing Address - Phone:605-228-4116
Mailing Address - Fax:
Practice Address - Street 1:1014 DULANEY VALLEY RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2702
Practice Address - Country:US
Practice Address - Phone:605-228-4116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02103171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist