Provider Demographics
NPI:1306229794
Name:LWANGA, DORCAS (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:DORCAS
Middle Name:
Last Name:LWANGA
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11456 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1305
Mailing Address - Country:US
Mailing Address - Phone:301-332-5783
Mailing Address - Fax:
Practice Address - Street 1:201 BALLARD AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220
Practice Address - Country:US
Practice Address - Phone:410-686-3931
Practice Address - Fax:410-686-3932
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3793133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered