Provider Demographics
NPI:1497208979
Name:PLONKA, BREINDEL (RDN, LDN, CDE, CNSC)
Entity Type:Individual
Prefix:
First Name:BREINDEL
Middle Name:
Last Name:PLONKA
Suffix:
Gender:F
Credentials:RDN, LDN, CDE, CNSC
Other - Prefix:
Other - First Name:BRENDEL
Other - Middle Name:
Other - Last Name:ROSSKAMM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN, LDN, CDE, CNSC
Mailing Address - Street 1:6105 WESTERN RUN DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3816
Mailing Address - Country:US
Mailing Address - Phone:410-500-8488
Mailing Address - Fax:
Practice Address - Street 1:1001 PINE HEIGHTS AVE STE 202
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5284
Practice Address - Country:US
Practice Address - Phone:410-500-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3833133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered