Healthcare Provider Details

I. General information

NPI: 1386012995
Provider Name (Legal Business Name): ANN KEATING CNS, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10440 SHAKER DR SUITE103
COLUMBIA MD
21046-1200
US

IV. Provider business mailing address

13321 DOVEDALE WAY APT G
GERMANTOWN MD
20874-4457
US

V. Phone/Fax

Practice location:
  • Phone: 240-246-5349
  • Fax:
Mailing address:
  • Phone: 301-704-2909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX3674
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: