Healthcare Provider Details

I. General information

NPI: 1093251324
Provider Name (Legal Business Name): THE CEDAR HEALTH GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6218 BLACK CHERRY CIRCLE
COLUMBIA MD
21045
US

IV. Provider business mailing address

6218 BLACK CHERRY CIRCLE
COLUMBIA MD
21045
US

V. Phone/Fax

Practice location:
  • Phone: 410-707-2779
  • Fax:
Mailing address:
  • Phone: 410-707-2779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD02091
License Number StateMD

VIII. Authorized Official

Name: DR. CHIMENE CASTOR
Title or Position: PRESIDENT
Credential:
Phone: 410-707-2779