Healthcare Provider Details

I. General information

NPI: 1912513821
Provider Name (Legal Business Name): PASSION4PROGRESSION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14204 OXFORD DRIVE
LAUREL MD
20707-5852
US

IV. Provider business mailing address

14204 OXFORD DRIVE
LAUREL MD
20707-5852
US

V. Phone/Fax

Practice location:
  • Phone: 301-346-0340
  • Fax:
Mailing address:
  • Phone: 301-346-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name: MR. CARL ANTHONY CHIAGORO
Title or Position: CEO
Credential:
Phone: 240-374-3088