Provider Demographics
NPI:1447393582
Name:DORSEY-SMITH, MONICA REGINA (RD, LDN, CDE)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:REGINA
Last Name:DORSEY-SMITH
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 W BELVEDERE AVE
Mailing Address - Street 2:HOFFBERGER 51
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5224
Mailing Address - Country:US
Mailing Address - Phone:410-601-5458
Mailing Address - Fax:410-601-7209
Practice Address - Street 1:2435 W BELVEDERE AVE
Practice Address - Street 2:HOFFBERGER 51
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5224
Practice Address - Country:US
Practice Address - Phone:410-601-5458
Practice Address - Fax:410-601-7209
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00499133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK453D491Medicare ID - Type Unspecified
MDP58893Medicare UPIN