Individual
MARY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
8100 BOONE BLVD STE 700, TYSONS, VA 22182-2683
(240) 670-5115
Mailing address
PO BOX 37174, BALTIMORE, MD 21297-3174
(571) 423-5699
(571) 423-5698
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86093641
VA
133V00000X
Registered Dietitian
DI100000929
DC
Other
Enumeration date
10/15/2017
Last updated
04/12/2022
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