Basic Information
Provider Information
NPI: 1851938104
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EARL
FirstName: LINDSEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MS, RD, LDN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7209 SLEEP SOFT CIR
Address2:  
City: COLUMBIA
State: MD
PostalCode: 210455252
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 10 N GREENE ST
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212011524
CountryCode: US
TelephoneNumber: 4106057000
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/05/2019
LastUpdateDate: 12/05/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000X86029227 Y Dietary & Nutritional Service ProvidersDietitian, Registered 

No ID Information.


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