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General NPI Number Information
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NPI Number | 1912513821
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Entity Type | Organization
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Legal Business Name | PASSION4PROGRESSION LLC
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Dates
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Enumeration Date | 09/17/2020
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Last Update Date | 09/17/2020
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Provider Practice Location Address
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Address Line | 14204 OXFORD DRIVE
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City | LAUREL
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State | MD
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Zip | 20707-5852
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Country | US
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Telephone | 301-346-0340
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Fax |
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Provider Business Mailing Address
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Address Line | 14204 OXFORD DRIVE
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City | LAUREL
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State | MD
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Zip | 20707-5852
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Country | US
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Telephone | 301-346-0340
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CARL ANTHONY CHIAGORO
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Credential |
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Telephone | 240-374-3088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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