Healthcare Provider Details

I. General information

NPI: 1063715159
Provider Name (Legal Business Name): MEREDITH ROSE MOELLER RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 SANDY CREEK RD
FORT WASHINGTON MD
20744-4838
US

IV. Provider business mailing address

9400 SANDY CREEK RD
FORT WASHINGTON MD
20744-4838
US

V. Phone/Fax

Practice location:
  • Phone: 302-593-1163
  • Fax:
Mailing address:
  • Phone: 302-593-1163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDN-0000417
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: