MEDICARE: MRS. CHRISTINE DAWN MCKINNEY RD

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	DO2307	MD

General Provider Information

NPI Number	:	1861437485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE DAWN MCKINNEY RD

Provider Business Mailing Address
First Line	:	1006 ROLAND HEIGHTS AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21211-1237
Country	:	US
Telephone Number	:	410-889-0450
Fax Number	:	410-550-0650

Provider Business Practice Location Address
First Line	:	4940 EASTERN AVENUE
Second Line	:	JOHNS HOPKINS BAYVIEW MEDICAL CENTER CLINICAL NUTRITION
City	:	BALTIMORE
State	:	MD
Zip	:	21224-2780
Country	:	US
Telephone Number	:	410-550-1549
Fax Number	:	410-550-0650

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	07/08/2007

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