Organization
GRO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN GOODMAN RD, LDN (REGISTERED DIETITIAN)
(410) 686-0459
Entity
Organization
Contact information
Practice address
1301 YORK RD STE 800, TIMONIUM, MD 21093-6011
(410) 686-0459
(425) 242-3401
Mailing address
1301 YORK RD STE 800, TIMONIUM, MD 21093-6011
(410) 686-0459
(425) 242-3401
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
05/17/2022
Last updated
02/05/2025
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