Healthcare Provider Details

I. General information

NPI: 1508600123
Provider Name (Legal Business Name): ABIGAIL EWEN MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4416 E WEST HWY STE 350
BETHESDA MD
20814-4577
US

IV. Provider business mailing address

4416 E WEST HWY STE 350
BETHESDA MD
20814-4577
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-4600
  • Fax:
Mailing address:
  • Phone: 301-656-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX6725
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: