Provider Demographics
NPI:1528004926
Name:BRONICH-HALL, LAUREN ANN (RD CDE)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ANN
Last Name:BRONICH-HALL
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 SAINT PAUL ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-3056
Mailing Address - Country:US
Mailing Address - Phone:443-692-3105
Mailing Address - Fax:443-692-3099
Practice Address - Street 1:1501 SAINT PAUL ST
Practice Address - Street 2:SUITE 118
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3056
Practice Address - Country:US
Practice Address - Phone:443-692-3105
Practice Address - Fax:443-692-3099
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01981133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered