Healthcare Provider Details

I. General information

NPI: 1477194058
Provider Name (Legal Business Name): HEATHER FLIEHMAN RD/LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER CHANDLER

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 LANDMARK DR STE 122
GLEN BURNIE MD
21061-4984
US

IV. Provider business mailing address

1589 SULPHUR SPRING RD STE 109
BALTIMORE MD
21227-2542
US

V. Phone/Fax

Practice location:
  • Phone: 410-760-3588
  • Fax: 410-760-3604
Mailing address:
  • Phone: 443-575-4880
  • Fax: 443-575-4891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberDX2881
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: