Healthcare Provider Details

I. General information

NPI: 1801791074
Provider Name (Legal Business Name): HANNAH AMELIA BURGESS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 CAMPBELL BLVD STE LM
NOTTINGHAM MD
21236-4968
US

IV. Provider business mailing address

1435 CHROME HILL RD
JARRETTSVILLE MD
21084-1635
US

V. Phone/Fax

Practice location:
  • Phone: 410-870-3808
  • Fax:
Mailing address:
  • Phone: 410-322-8591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX9003
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: