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General NPI Number Information
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NPI Number | 1992822217
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Entity Type | Individual
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Provider Name | KEVIN SCOTT GRODNITZKY M.S., R.D., L.D.N.
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Gender | Male
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 1501 DIVISION ST
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City | BALTIMORE
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State | MD
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Zip | 21217-3121
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Country | US
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Telephone | 410-728-4091
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Fax |
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Provider Business Mailing Address
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Address Line | 1 TROTTERS CT APT 102
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City | PIKESVILLE
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State | MD
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Zip | 21208-6722
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Country | US
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Telephone | 917-576-4115
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | DX2677
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DX2677
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License Number State | MD
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