Provider Demographics
NPI:1043448202
Name:SEYMOUR, TARA ROSE (RD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:ROSE
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N WOLFE ST
Mailing Address - Street 2:CMSCB100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-3051
Mailing Address - Country:US
Mailing Address - Phone:410-955-5787
Mailing Address - Fax:410-614-9072
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:CMSCB100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-3051
Practice Address - Country:US
Practice Address - Phone:410-955-5787
Practice Address - Fax:410-614-9072
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY992177133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered