Healthcare Provider Details

I. General information

NPI: 1730396714
Provider Name (Legal Business Name): ARAMARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5216
US

IV. Provider business mailing address

103 E RANDALL ST
BALTIMORE MD
21230-4609
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-5728
  • Fax:
Mailing address:
  • Phone: 410-371-0887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberDX2468
License Number StateMD

VIII. Authorized Official

Name: LORETTA GORE
Title or Position: PEDIATRIC DIETITIAN
Credential: MS, RD, LDN
Phone: 410-601-5728