Provider Demographics
NPI:1407566078
Name:MARYLAND DIETITIAN GROUP
Entity Type:Organization
Organization Name:MARYLAND DIETITIAN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:718-877-4937
Mailing Address - Street 1:7440 SAN CLEMENTE PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-1005
Mailing Address - Country:US
Mailing Address - Phone:718-877-4937
Mailing Address - Fax:
Practice Address - Street 1:6110 RUSK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4106
Practice Address - Country:US
Practice Address - Phone:347-746-0453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty