Healthcare Provider Details

I. General information

NPI: 1093947483
Provider Name (Legal Business Name): EVA RAND RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10215 FERNWOOD RD SUITE 100
BETHESDA MD
20817-1106
US

IV. Provider business mailing address

10215 FERNWOOD RD SUITE 100
BETHESDA MD
20817-1106
US

V. Phone/Fax

Practice location:
  • Phone: 301-547-0569
  • Fax: 301-493-5532
Mailing address:
  • Phone: 301-547-0569
  • Fax: 301-493-5532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD02405
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: