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General NPI Number Information
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NPI Number | 1366557670
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Entity Type | Individual
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Provider Name | AUDREY DAGMAR TOMERLIN RD,LDN
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Gender | Female
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 600 N WOLFE ST CMSC B100
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City | BALTIMORE
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State | MD
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Zip | 21287-0005
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Country | US
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Telephone | 410-955-6716
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Fax | 410-614-6929
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Provider Business Mailing Address
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Address Line | 329 HOMELAND SOUTHWAY APT 1A
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City | BALTIMORE
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State | MD
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Zip | 21212-4121
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Country | US
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Telephone | 410-433-1619
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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 | DX2436
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License Number State | MD
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