Provider Demographics
NPI:1063982221
Name:GORDON, DAHLIA K (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:DAHLIA
Middle Name:K
Last Name:GORDON
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 HAWTHORNE LN APT 227
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-2994
Mailing Address - Country:US
Mailing Address - Phone:828-482-5553
Mailing Address - Fax:
Practice Address - Street 1:1101 HAWTHORNE LN APT 227
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-2994
Practice Address - Country:US
Practice Address - Phone:828-482-5553
Practice Address - Fax:866-359-7702
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005640133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered