Healthcare Provider Details

I. General information

NPI: 1629284948
Provider Name (Legal Business Name): MARGERY REESE PEPPER PHD, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: M. REESE PEPPER PHD, RD

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 S HANOVER ST
BALTIMORE MD
21230-4420
US

IV. Provider business mailing address

1613 S HANOVER ST
BALTIMORE MD
21230-4420
US

V. Phone/Fax

Practice location:
  • Phone: 512-799-2229
  • Fax: 410-706-5090
Mailing address:
  • Phone: 512-799-2229
  • Fax: 410-706-5030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT07730
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDT07730
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX3149
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: