Healthcare Provider Details

I. General information

NPI: 1982710372
Provider Name (Legal Business Name): DECHEN PAYDON SURKHANG RD LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

6308 BLACKBURN CT
BALTIMORE MD
21212-2220
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5787
  • Fax: 410-614-9072
Mailing address:
  • Phone: 410-377-9092
  • Fax: 410-614-9072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDOO548
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: