Provider Demographics
NPI:1467414318
Name:PAPASTEPHANOU, JENNIFER (MS RD LDN CDE)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PAPASTEPHANOU
Suffix:
Gender:F
Credentials:MS RD LDN CDE
Other - Prefix:
Other - First Name:THE
Other - Middle Name:NUTRITION
Other - Last Name:CONNECTION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLC
Mailing Address - Street 1:203 PURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5252
Mailing Address - Country:US
Mailing Address - Phone:410-321-5050
Mailing Address - Fax:410-321-5050
Practice Address - Street 1:1734 YORK RD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5606
Practice Address - Country:US
Practice Address - Phone:410-321-5050
Practice Address - Fax:410-321-5050
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDN00262133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD16NUOtherBLUE CROSS BLUE SHIELD
MD974RMedicare ID - Type Unspecified
MD16NUOtherBLUE CROSS BLUE SHIELD