Healthcare Provider Details

I. General information

NPI: 1265891329
Provider Name (Legal Business Name): JANET H MCDONALD RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 STEEPLE CHASE DR SUITE 307
PRINCE FREDERICK MD
20678-4053
US

IV. Provider business mailing address

PO BOX 2424
PRINCE FREDERICK MD
20678-2424
US

V. Phone/Fax

Practice location:
  • Phone: 443-432-3020
  • Fax: 443-486-7178
Mailing address:
  • Phone: 410-535-2085
  • Fax: 410-535-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD00376
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: