Provider Demographics
NPI:1982417556
Name:HONG, MARYBETH
Entity type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:HONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 BALTIMORE NATIONAL PIKE STE 1
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4286
Mailing Address - Country:US
Mailing Address - Phone:443-420-3120
Mailing Address - Fax:
Practice Address - Street 1:8585 BALTIMORE NATIONAL PIKE STE 1
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4286
Practice Address - Country:US
Practice Address - Phone:443-420-3120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02580171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty