Healthcare Provider Details

I. General information

NPI: 1730378118
Provider Name (Legal Business Name): EMILY CARTWRIGHT POOLE RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13011 CLARKSBURG SQUARE RD
CLARKSBURG MD
20871-4399
US

IV. Provider business mailing address

13011 CLARKSBURG SQUARE RD
CLARKSBURG MD
20871-4399
US

V. Phone/Fax

Practice location:
  • Phone: 301-922-0061
  • Fax:
Mailing address:
  • Phone: 301-922-0061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD02375
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: