Healthcare Provider Details

I. General information

NPI: 1528626751
Provider Name (Legal Business Name): ADELINE ASSANI-UVA RD LDN CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S CATON AVE
BALTIMORE MD
21229-5201
US

IV. Provider business mailing address

18207 COACHMANS RD
GERMANTOWN MD
20874-2221
US

V. Phone/Fax

Practice location:
  • Phone: 667-234-8743
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: