MEDICARE: GABRIELLE ALEXANDRA JUDD RD, CNSC, LDN

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	DX3646	MD

General Provider Information

NPI Number	:	1801468202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE ALEXANDRA JUDD RD, CNSC, LDN

Provider Business Mailing Address
First Line	:	236 S HIGH ST APT 5
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-4431
Country	:	US
Telephone Number	:	803-370-1281
Fax Number	:

Provider Business Practice Location Address
First Line	:	236 S HIGH ST APT 5
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-4431
Country	:	US
Telephone Number	:	803-370-1281
Fax Number	:

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

Provider Enumeration Date	:	07/14/2021
Last Update Date	:	07/14/2021

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