Provider Demographics
NPI:1508332933
Name:BRIDGES, MARIE THERESE (MS, RDN, CEDS)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:THERESE
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:MS, RDN, CEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W LOMBARD ST
Mailing Address - Street 2:PMB 1218
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223
Mailing Address - Country:US
Mailing Address - Phone:646-484-9849
Mailing Address - Fax:
Practice Address - Street 1:1400 W LOMBARD ST
Practice Address - Street 2:PMB 1218
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223
Practice Address - Country:US
Practice Address - Phone:646-484-9849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX6047133V00000X
AL5289133V00000X
NY008910133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered