1518398346 NPI number — EMILY SUSAN DRUDUL MS, RD, LDN, CNSC

Table of content: EMILY SUSAN DRUDUL MS, RD, LDN, CNSC (NPI 1518398346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518398346 NPI number — EMILY SUSAN DRUDUL MS, RD, LDN, CNSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRUDUL
Provider First Name:
EMILY
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, LDN, CNSC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
EMILY
Provider Other Middle Name:
SUSAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, RD, LDN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518398346
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 S HANOVER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21225-1233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-350-3273
Provider Business Mailing Address Fax Number:
410-350-3051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 S HANOVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21225-1233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-350-3273
Provider Business Practice Location Address Fax Number:
410-350-3051
Provider Enumeration Date:
12/04/2013

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: 133N00000X , with the licence number:  DX3211 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: CDR 1010367 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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