Individual
CATHARINE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LDN, CNS
Contact information
Practice address
2535 WATERSIDE DR, FREDERICK, MD 21701-3211
(301) 695-1114
Mailing address
2535 WATERSIDE DR, FREDERICK, MD 21701-3211
(301) 695-1114
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
DX2904
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46-0575525
IRS
MD
01
—
DX2904
STATE LICENSE (LDN)
MD
Enumeration date
07/20/2012
Last updated
07/20/2012
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