Provider Demographics
NPI:1255074720
Name:GEORGE, TESIA (RDN)
Entity type:Individual
Prefix:MISS
First Name:TESIA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SCHILLING RD STE 40
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1104
Mailing Address - Country:US
Mailing Address - Phone:410-999-1332
Mailing Address - Fax:
Practice Address - Street 1:101 SCHILLING RD STE 40A
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1137
Practice Address - Country:US
Practice Address - Phone:410-427-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00906601133V00000X
MDDX5001133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered