Provider Demographics
NPI:1396850913
Name:LEE, RACHEL Y (RDLD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:Y
Last Name:LEE
Suffix:
Gender:F
Credentials:RDLD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDLD
Mailing Address - Street 1:6314 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5260
Mailing Address - Country:US
Mailing Address - Phone:410-955-5787
Mailing Address - Fax:410-614-6929
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-5787
Practice Address - Fax:410-614-6929
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD882896133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered