Provider Demographics
NPI:1013589647
Name:ORT, KELLY ANN (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:ORT
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:BARTON-ORT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN, LDN
Mailing Address - Street 1:2115 CORBETT RD
Mailing Address - Street 2:
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-2021
Mailing Address - Country:US
Mailing Address - Phone:410-615-4437
Mailing Address - Fax:
Practice Address - Street 1:BALTIMORE VA MEDICAL CENTER
Practice Address - Street 2:10 NORTH GREENE STREET
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:443-421-5362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01280133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered