Healthcare Provider Details

I. General information

NPI: 1023500402
Provider Name (Legal Business Name): LORAN GRIFFITH MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORAN PARK

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST JHH, DEPT OF NUTRITION, WEINBERG BLDG, L2, B3100
BALTIMORE MD
21287
US

IV. Provider business mailing address

35 WOLF TRAP CT
NOTTINGHAM MD
21236-2556
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-1637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX4388
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: