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General NPI Number Information
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NPI Number | 1528623865
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Entity Type | Individual
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Provider Name | DORA PASSEN MS, CNS, LDN
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Gender | Female
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 216 SAINT DUNSTANS RD
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City | BALTIMORE
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State | MD
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Zip | 21212-3409
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Country | US
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Telephone | 410-952-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 301 N BIRCH RD APT 9N
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-4282
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Country | US
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Telephone | 410-952-4400
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | DX4698
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License Number State | MD
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