Provider Demographics
NPI:1619057981
Name:SPENCE, ROBIN L (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:L
Last Name:SPENCE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E UNIVERSITY PKWY
Mailing Address - Street 2:CARDIAC REHABILITATION
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2829
Mailing Address - Country:US
Mailing Address - Phone:410-554-4356
Mailing Address - Fax:410-554-2661
Practice Address - Street 1:201 E UNIVERSITY PKWY
Practice Address - Street 2:CARDIAC REHABILITATION
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2829
Practice Address - Country:US
Practice Address - Phone:410-554-4356
Practice Address - Fax:410-554-2661
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00634133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ51954Medicare UPIN
MDK453M407Medicare ID - Type Unspecified