Provider Demographics
NPI:1881256840
Name:PELL, ERIN (CNS, LDN, CDN)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:PELL
Suffix:
Gender:F
Credentials:CNS, LDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 TRAFALGAR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-3805
Mailing Address - Country:US
Mailing Address - Phone:732-778-3894
Mailing Address - Fax:
Practice Address - Street 1:805 TRAFALGAR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-3805
Practice Address - Country:US
Practice Address - Phone:732-778-3894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-30
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4650133N00000X
NY009857-1133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist