Provider Demographics
NPI:1407962996
Name:TE, PURITA L (RD;LD)
Entity type:Individual
Prefix:
First Name:PURITA
Middle Name:L
Last Name:TE
Suffix:
Gender:F
Credentials:RD;LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3419 UPTON RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3345
Mailing Address - Country:US
Mailing Address - Phone:410-955-0731
Mailing Address - Fax:410-614-6929
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-0731
Practice Address - Fax:410-614-6929
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered