MEDICARE: MERRITT ATHLETIC CLUBS, LLC

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

General Provider Information

NPI Number	:	1710523519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERRITT ATHLETIC CLUBS, LLC

Provider Business Mailing Address
First Line	:	2058 LORD BALTIMORE DR
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21244-2501
Country	:	US
Telephone Number	:	410-298-8705
Fax Number	:

Provider Business Practice Location Address
First Line	:	2058 LORD BALTIMORE DR
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21244-2501
Country	:	US
Telephone Number	:	410-298-8705
Fax Number	:

Authorized Official
Title or Position	:	WELLNESS DIRECTOR
Name	:	LINDSAY SILBERT
Credential	:
Telephone Number	:	410-298-8705

Provider Enumeration Date	:	11/27/2019
Last Update Date	:	01/10/2020

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