Healthcare Provider Details

I. General information

NPI: 1013700830
Provider Name (Legal Business Name): DIERDRE BEARD CNS, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON AVE FL 5 #86
TOWSON MD
21204-4763
US

IV. Provider business mailing address

200 WASHINGTON AVE FL 5 #86
TOWSON MD
21204-4763
US

V. Phone/Fax

Practice location:
  • Phone: 423-202-5685
  • Fax:
Mailing address:
  • Phone: 423-202-5685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX7290
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: