Healthcare Provider Details

I. General information

NPI: 1679509897
Provider Name (Legal Business Name): EMILY SMITH LOGHMANI R.D, L.D, C.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N CAROLINE ST
BALTIMORE MD
21287-0006
US

IV. Provider business mailing address

PO BOX 64264
BALTIMORE MD
21264-4264
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-2816
  • Fax: 410-614-9586
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number443
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX2800
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: