Provider Demographics
NPI:1235430380
Name:DINGLE, LORI NICHELLE
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:NICHELLE
Last Name:DINGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7635 TALL PIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6576
Mailing Address - Country:US
Mailing Address - Phone:301-509-5363
Mailing Address - Fax:410-796-4718
Practice Address - Street 1:7635 TALL PIN OAK DR
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6576
Practice Address - Country:US
Practice Address - Phone:301-509-5363
Practice Address - Fax:410-796-4718
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100000185133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC046727600Medicaid