Provider Demographics
NPI:1700253069
Name:BLUMBERG, JANA ELIZABETH (RD, LDN, CPT)
Entity Type:Individual
Prefix:MS
First Name:JANA
Middle Name:ELIZABETH
Last Name:BLUMBERG
Suffix:
Gender:F
Credentials:RD, LDN, CPT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:BLUMBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LDN, CPT
Mailing Address - Street 1:6319 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3905
Mailing Address - Country:US
Mailing Address - Phone:301-231-0026
Mailing Address - Fax:301-231-0039
Practice Address - Street 1:6319 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3905
Practice Address - Country:US
Practice Address - Phone:301-231-0026
Practice Address - Fax:301-231-0039
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDN00252133N00000X
MD854730133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist