Provider Demographics
NPI:1255364410
Name:COSBY, ADRIANE STITES (MS RD LDN)
Entity type:Individual
Prefix:
First Name:ADRIANE
Middle Name:STITES
Last Name:COSBY
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:ADRIANE
Other - Middle Name:DANA
Other - Last Name:STITES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS RD LDN
Mailing Address - Street 1:6535 N CHARLES ST
Mailing Address - Street 2:STE 300
Mailing Address - City:BALTO
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-938-5252
Mailing Address - Fax:410-938-5250
Practice Address - Street 1:6535 N CHARLES ST
Practice Address - Street 2:STE 300
Practice Address - City:BALTO
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-938-5252
Practice Address - Fax:410-938-5250
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD02389133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education