1134516529 NPI number — CHRISTY PICKERING GRODNITZKY MA, RD, LDN

Table of content: CHRISTY PICKERING GRODNITZKY MA, RD, LDN (NPI 1134516529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134516529 NPI number — CHRISTY PICKERING GRODNITZKY MA, RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRODNITZKY
Provider First Name:
CHRISTY
Provider Middle Name:
PICKERING
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, RD, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134516529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
57 W TIMONIUM RD
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
LUTHERVILLE TIMONIUM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21093-3125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-989-1886
Provider Business Mailing Address Fax Number:
410-630-1668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57 W TIMONIUM RD
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
LUTHERVILLE TIMONIUM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-3125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-989-1886
Provider Business Practice Location Address Fax Number:
410-630-1668
Provider Enumeration Date:
04/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  DX2713 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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