Provider Demographics
NPI:1548677560
Name:GRANDEA, KARA (MOM, LAC)
Entity type:Individual
Prefix:MS
First Name:KARA
Middle Name:
Last Name:GRANDEA
Suffix:
Gender:F
Credentials:MOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8182 LARK BROWN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6428
Mailing Address - Country:US
Mailing Address - Phone:410-375-9607
Mailing Address - Fax:
Practice Address - Street 1:8182 LARK BROWN RD STE 102
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6428
Practice Address - Country:US
Practice Address - Phone:410-375-9607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01966171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist