Provider Demographics
NPI:1437820354
Name:COLACO, DONNA (LAC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:COLACO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 OLD WASHINGTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3238
Mailing Address - Country:US
Mailing Address - Phone:240-343-2533
Mailing Address - Fax:
Practice Address - Street 1:3500 OLD WASHINGTON RD STE 201
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3238
Practice Address - Country:US
Practice Address - Phone:240-343-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02827171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist