MEDICARE: NIKITA SAMIR GORADIA RDN,LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DX2857	MD

General Provider Information

NPI Number	:	1073021127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKITA SAMIR GORADIA RDN,LDN

Provider Business Mailing Address
First Line	:	4719 COLUMBIA HILLS CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6409
Country	:	US
Telephone Number	:	410-419-9874
Fax Number	:

Provider Business Practice Location Address
First Line	:	4719 COLUMBIA HILLS CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6409
Country	:	US
Telephone Number	:	410-419-9874
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2018
Last Update Date	:	01/10/2018

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