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General NPI Number Information
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NPI Number | 1093361057
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Entity Type | Organization
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Legal Business Name | CUSTOM MADE WEIGHT LOSS AND NURSING SOLUTIONS
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Dates
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Enumeration Date | 08/15/2019
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 372 MAIN ST STE 2
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City | LAUREL
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State | MD
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Zip | 20707-4133
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Country | US
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Telephone | 240-294-4079
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Fax |
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Provider Business Mailing Address
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Address Line | 372 MAIN ST STE 2
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City | LAUREL
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State | MD
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Zip | 20707-4133
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Country | US
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Telephone | 240-294-4079
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Fax | 240-559-0085
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Authorized Official
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Title or Position | CEO
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Name | BERMESOLA M DYER
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Credential |
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Telephone | 202-505-5207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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