Individual
MS. JESSICA DECOSTOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RDN, LDN, CDE
Contact information
Practice address
5601 LOCH RAVEN BLVD, GOOD HEALTH CENTER 2ND FLOOR, BALTIMORE, MD 21238
(443) 444-4912
(443) 444-4884
Mailing address
736 S ELLWOOD AVE, BALTIMORE, MD 21224-3949
(347) 992-4041
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DX3562
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DX3562
THE BOARD OF DIETETIC PRACTICE OF THE STATE OF MARYLAND
MD
Enumeration date
03/20/2015
Last updated
05/04/2018
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