Healthcare Provider Details

I. General information

NPI: 1518654839
Provider Name (Legal Business Name): SCOTT MAHER RD, CSSD, LD, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 LITTLE CURRENT DR
ANNAPOLIS MD
21409-5643
US

IV. Provider business mailing address

509 LITTLE CURRENT DR
ANNAPOLIS MD
21409-5643
US

V. Phone/Fax

Practice location:
  • Phone: 732-629-4319
  • Fax:
Mailing address:
  • Phone: 732-629-4319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX4678
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number86054596
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: