Provider Demographics
NPI:1326203563
Name:DOBRZYKOWSKI, ANGELA KERRY (MS, RD, CSP, LDN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KERRY
Last Name:DOBRZYKOWSKI
Suffix:
Gender:F
Credentials:MS, RD, CSP, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 KENILWORTH DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2139
Mailing Address - Country:US
Mailing Address - Phone:717-475-9970
Mailing Address - Fax:
Practice Address - Street 1:903 CROMWELL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3323
Practice Address - Country:US
Practice Address - Phone:410-601-5727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2715133VN1004X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK676Medicare PIN
MDK938Medicare PIN