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General NPI Number Information
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NPI Number | 1811280035
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Entity Type | Organization
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Legal Business Name | HEALTHY SHAPES LLC
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Dates
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Enumeration Date | 05/20/2011
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Last Update Date | 05/20/2011
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Provider Practice Location Address
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Address Line | 10760 HICKORY RIDGE RD SUITE 125
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City | COLUMBIA
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State | MD
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Zip | 21044-3682
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Country | US
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Telephone | 410-300-4545
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Fax | 443-283-4477
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Provider Business Mailing Address
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Address Line | PO BOX 2727
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City | COLUMBIA
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State | MD
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Zip | 21045-1727
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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 | SOLE PROPRIETOR
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Name | DR. ROBERT CADOGAN
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Credential | MD
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Telephone | 410-300-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0051318
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License Number State | MD
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