Provider Demographics
NPI:1407550908
Name:GORDON, HARRIET IRENE (RD, LDN)
Entity type:Individual
Prefix:
First Name:HARRIET
Middle Name:IRENE
Last Name:GORDON
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:HARRIET
Other - Middle Name:IRENE
Other - Last Name:TSUGRANES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1217 GRAYCLIFF LN
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1698
Mailing Address - Country:US
Mailing Address - Phone:302-824-9579
Mailing Address - Fax:
Practice Address - Street 1:1217 GRAYCLIFF LN
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1698
Practice Address - Country:US
Practice Address - Phone:302-824-9579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4887133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered