Healthcare Provider Details

I. General information

NPI: 1417629247
Provider Name (Legal Business Name): CAITLYN LAZORKA RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11221 DOLFIELD BLVD
OWINGS MILLS MD
21117-3254
US

IV. Provider business mailing address

8915 EARLY APRIL WAY
COLUMBIA MD
21046-2408
US

V. Phone/Fax

Practice location:
  • Phone: 443-381-2321
  • Fax:
Mailing address:
  • Phone: 443-381-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: