| Brendel Plonka Rdn, Llc | |
|
6105 Western Run Dr Baltimore MD 21209-3816 | |
| (410) 500-8488 | |
| Not Available |
| Full Name | Brendel Plonka Rdn, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6105 Western Run Dr, Baltimore, Maryland |
| Authorized Official Name and Position | Breindel Plonka (OWNER) |
| Authorized Official Contact | 4105008488 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brendel Plonka Rdn, Llc 4000 W Strathmore Ave Baltimore MD 21215-3406 Ph: (410) 500-8488 | Brendel Plonka Rdn, Llc 6105 Western Run Dr Baltimore MD 21209-3816 Ph: (410) 500-8488 |
| NPI Number | 1588305213 |
|---|---|
| Provider Enumeration Date | 04/05/2022 |
| Last Update Date | 06/27/2022 |
| Medicare PECOS PAC ID | 5496130197 |
|---|---|
| Medicare Enrollment ID | O20220916000055 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588305213 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Breindel Plonka |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1497208979 PECOS PAC ID: 4587049283 Enrollment ID: I20220916000051 |
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