Healthcare Provider Details

I. General information

NPI: 1063892461
Provider Name (Legal Business Name): LINDSAY STANDER RD, LDN, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

302 S MADEIRA ST
BALTIMORE MD
21231-2741
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-2568
  • Fax: 410-955-4870
Mailing address:
  • Phone: 410-790-9080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX3201
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: