Basic Information
Provider Information
NPI: 1013003821
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADAMS
FirstName: DEBORAH
MiddleName: KAY
NamePrefix:  
NameSuffix:  
Credential: R.D., L.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 602 KENNINGTON RD
Address2:  
City: REISTERSTOWN
State: MD
PostalCode: 211366419
CountryCode: US
TelephoneNumber: 4108331645
FaxNumber:  
Practice Location
Address1: 10 N GREENE ST
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212011524
CountryCode: US
TelephoneNumber: 4106057000
FaxNumber: 4106057835
Other Information
ProviderEnumerationDate: 10/05/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000XD00552MDY Dietary & Nutritional Service ProvidersDietitian, Registered 

No ID Information.


Home