Angela Boadu, R.D., L.D.N./L.D.

Primary specialty

Pediatric Nutrition Registered DietitianTaxonomy code 133VN1004X

License

DX3295 Issued in MD

Practice address

13922 Baltimore Ave
Suite 4a
Laurel, MD 20707-5009

Phone

(202) 476-6354

Fax

(240) 568-7010

NPI assigned

Feb 19, 2013

Last updated

Feb 19, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1361232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361232000000",
    "number": "1639419278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 MICHIGAN AVE NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200102916",
            "telephone_number": "202-476-6354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13922 BALTIMORE AVE",
            "address_2": "SUITE 4A",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207075009",
            "telephone_number": "202-476-6354",
            "fax_number": "240-568-7010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOADU",
        "first_name": "ANGELA",
        "name_prefix": "Ms.",
        "credential": "R.D., L.D.N./L.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-19",
        "last_updated": "2013-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "MD",
            "license": "DX3295",
            "primary": true
        },
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "DC",
            "license": "DI100000547",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Nutrition Registered Dietitian in Laurel, MD
• Providers in Laurel, MD by specialty
• Pediatric Nutrition Registered Dietitian in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.