Healthcare Provider Details

I. General information

NPI: 1609443613
Provider Name (Legal Business Name): MALERIE FISHER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

524 BAY HILLS DR
ARNOLD MD
21012-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-6716
  • Fax:
Mailing address:
  • Phone: 620-253-0472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX5087
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: