Healthcare Provider Details

I. General information

NPI: 1578546198
Provider Name (Legal Business Name): DARLENE ANNE JAMESON R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9733 HEALTHWAY DR
BERLIN MD
21811-1155
US

IV. Provider business mailing address

211 HENRYS MILL DR
BERLIN MD
21811-1461
US

V. Phone/Fax

Practice location:
  • Phone: 410-641-9773
  • Fax:
Mailing address:
  • Phone: 410-641-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDO1488
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: