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General NPI Number Information
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NPI Number | 1124323829
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Entity Type | Individual
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Provider Name | CONNIE BINGHAM R.D., L.D.
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Gender | Female
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Dates
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Enumeration Date | 01/11/2011
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 3804 BLADENSBURG RD
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City | COTTAGE CITY
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State | MD
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Zip | 20722-1613
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Country | US
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Telephone | 301-277-2704
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Fax |
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Provider Business Mailing Address
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Address Line | 3804 BLADENSBURG RD
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City | COTTAGE CITY
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State | MD
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Zip | 20722-1613
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DO1745
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License Number State | MD
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