Healthcare Provider Details

I. General information

NPI: 1235674698
Provider Name (Legal Business Name): BLANCA SOLEDAD MEJIA MS,NL,CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 MEDICAL CAMPUS RD STE 108
HAGERSTOWN MD
21742-6734
US

IV. Provider business mailing address

3300 CLARKS LN APT A
BALTIMORE MD
21215-2624
US

V. Phone/Fax

Practice location:
  • Phone: 301-714-4041
  • Fax:
Mailing address:
  • Phone: 443-835-7721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberDX4039
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: