Provider Demographics
NPI:1194956458
Name:GINN-MEADOW, ANGELA J (RD LDN CDE)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:J
Last Name:GINN-MEADOW
Suffix:
Gender:F
Credentials:RD LDN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 PARK AVE
Mailing Address - Street 2:APT 413
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5640
Mailing Address - Country:US
Mailing Address - Phone:410-225-8145
Mailing Address - Fax:443-552-2991
Practice Address - Street 1:1020 PARK AVE
Practice Address - Street 2:APT 413
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5640
Practice Address - Country:US
Practice Address - Phone:410-225-8145
Practice Address - Fax:443-552-2991
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD02362133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD133VN1006XOtherUNITED HEALTH CARE
MD133VN1006XOtherBCBS
MD133VN1006XOtherAETNA
MD133VN1006XOtherMAMSI
MD133VN1006XOtherCIGNA
MD133VN1006XMedicaid
MD133VN1006XMedicare PIN