Provider Demographics
NPI:1790258705
Name:ROBERTS, ASHLEY (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ROBERTS
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 1:306 E FORT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4630
Mailing Address - Country:US
Mailing Address - Phone:570-898-3721
Mailing Address - Fax:
Practice Address - Street 1:1001 CROMWELL BRIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3329
Practice Address - Country:US
Practice Address - Phone:443-991-4914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4049133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered