Provider Demographics
NPI:1619365145
Name:DEENA MAEL RD LLC
Entity Type:Organization
Organization Name:DEENA MAEL RD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAEL
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:443-857-7511
Mailing Address - Street 1:2526 FARRINGDON RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2543
Mailing Address - Country:US
Mailing Address - Phone:443-857-7511
Mailing Address - Fax:
Practice Address - Street 1:2526 FARRINGDON RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2543
Practice Address - Country:US
Practice Address - Phone:443-857-7511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3204133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty