Provider Demographics
NPI:1043585607
Name:HUGH, LISA (RD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HUGH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 CRAIN HWY
Mailing Address - Street 2:STE 12
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3084
Mailing Address - Country:US
Mailing Address - Phone:240-210-9725
Mailing Address - Fax:240-366-1161
Practice Address - Street 1:4560 CRAIN HWY
Practice Address - Street 2:STE 12
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3084
Practice Address - Country:US
Practice Address - Phone:240-210-9725
Practice Address - Fax:240-366-1161
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2017-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDO2284133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered