Provider Demographics
NPI:1538216932
Name:CONDON, JO ELLEN (RD, LD, CDE)
Entity type:Individual
Prefix:MRS
First Name:JO ELLEN
Middle Name:
Last Name:CONDON
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:MISS
Other - First Name:JO ELLEN
Other - Middle Name:
Other - Last Name:DOBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:192A S SOUTHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4026
Mailing Address - Country:US
Mailing Address - Phone:410-487-2779
Mailing Address - Fax:410-280-2278
Practice Address - Street 1:192A S SOUTHWOOD AVE
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4026
Practice Address - Country:US
Practice Address - Phone:410-487-2779
Practice Address - Fax:410-280-2278
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2531133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD787019OtherMEDICARE
166237OtherNATIONAL CERTIFICATION BOARD FOR DIABETES EDUCATORS
MDDX2531OtherMARYLAND STATE BOARD OF DIETETIC PRACTICE
725845OtherAMERICAN DIETETIC ASSOCIATION