Healthcare Provider Details

I. General information

NPI: 1225463532
Provider Name (Legal Business Name): KATHLEEN LANDERS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEDICAL PKWY SUITE 605
ANNAPOLIS MD
21401-3742
US

IV. Provider business mailing address

PO BOX 12622
BELFAST ME
04915-4017
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-5667
  • Fax: 410-266-9332
Mailing address:
  • Phone: 443-481-6460
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX2465
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: