Provider Demographics
NPI:1639419278
Name:BOADU, ANGELA (RD, LDN/LD)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:BOADU
Suffix:
Gender:F
Credentials:RD, LDN/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MICHIGAN AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2916
Mailing Address - Country:US
Mailing Address - Phone:202-476-6354
Mailing Address - Fax:
Practice Address - Street 1:13922 BALTIMORE AVE
Practice Address - Street 2:SUITE 4A
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5009
Practice Address - Country:US
Practice Address - Phone:202-476-6354
Practice Address - Fax:240-568-7010
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3295133VN1004X
DCDI100000547133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric