Healthcare Provider Details

I. General information

NPI: 1992938799
Provider Name (Legal Business Name): AMANDA MARIE HAWVER RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 FRANKLIN SQUARE DR SUITE # 205
BALTIMORE MD
21237-3936
US

IV. Provider business mailing address

9732 SELFRIDGE RD
MIDDLE RIVER MD
21220-3783
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-2000
  • Fax:
Mailing address:
  • Phone: 443-730-2410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX2731
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: