Healthcare Provider Details

I. General information

NPI: 1306229794
Provider Name (Legal Business Name): DORCAS LWANGA RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BALLARD AVE
MIDDLE RIVER MD
21220
US

IV. Provider business mailing address

11456 CONNECTICUT AVE
KENSINGTON MD
20895-1305
US

V. Phone/Fax

Practice location:
  • Phone: 410-686-3931
  • Fax: 410-686-3932
Mailing address:
  • Phone: 301-332-5783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX3793
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: