Provider Demographics
NPI:1760602981
Name:ORDON, RENATA (RD)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:ORDON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 COLLEGE PKWY
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2912
Mailing Address - Country:US
Mailing Address - Phone:410-431-5106
Mailing Address - Fax:410-431-5051
Practice Address - Street 1:305 COLLEGE PKWY
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2912
Practice Address - Country:US
Practice Address - Phone:410-431-5106
Practice Address - Fax:410-431-5051
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2601133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered