Organization
FOUR COUNTY NUTRITION, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY STAMATES ROERTY RD (OWNER)
(240) 215-5084
Entity
Organization
Contact information
Practice address
1104 VILLAGE OAKS DR, MOUNT AIRY, MD 21771-5378
(240) 215-5084
Mailing address
1104 VILLAGE OAKS DR, MOUNT AIRY, MD 21771-5378
(240) 215-5084
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D01409
MD
Other
Enumeration date
05/01/2008
Last updated
10/03/2008
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