Healthcare Provider Details

I. General information

NPI: 1336910207
Provider Name (Legal Business Name): MEDSTAR HEALTH WEIGHT MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 MOUNTAIN RD STE G
PASADENA MD
21122-1158
US

IV. Provider business mailing address

1099 WINTERSON RD STE 300
LINTHICUM HEIGHTS MD
21090-2279
US

V. Phone/Fax

Practice location:
  • Phone: 410-255-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: RONDA RICHERT
Title or Position: VP REVENUE CYCLE OPERATIONS
Credential:
Phone: 800-905-3261