Healthcare Provider Details

I. General information

NPI: 1639627151
Provider Name (Legal Business Name): MORGAN DENHARD RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST BLOOMBERG BUILDING RM 9306
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

1800 ORLEANS ST BLOOMBERG BUILDING RM 9306
BALTIMORE MD
21287-0010
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDX3684
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: