MEDICARE: JENNIFER PAPASTEPHANOU MS RD LDN CDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	N00262	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16NU	OTHER	MD	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1467414318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER PAPASTEPHANOU MS RD LDN CDE

Provider Business Mailing Address
First Line	:	203 PURLINGTON RD
Second Line	:
City	:	LUTHERVILLE
State	:	MD
Zip	:	21093-5252
Country	:	US
Telephone Number	:	410-321-5050
Fax Number	:	410-321-5050

Provider Business Practice Location Address
First Line	:	1734 YORK RD
Second Line	:
City	:	LUTHERVILLE
State	:	MD
Zip	:	21093-5606
Country	:	US
Telephone Number	:	410-321-5050
Fax Number	:	410-321-5050

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	06/04/2012

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