Healthcare Provider Details

I. General information

NPI: 1841001252
Provider Name (Legal Business Name): RODNEY HOLMAN RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 MCDONOGH ST
BALTIMORE MD
21213-3129
US

IV. Provider business mailing address

1118 MCDONOGH ST
BALTIMORE MD
21213-3129
US

V. Phone/Fax

Practice location:
  • Phone: 410-262-6718
  • Fax:
Mailing address:
  • Phone: 410-262-6718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number86151760
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number86151760
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86151760
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: