Healthcare Provider Details

I. General information

NPI: 1790233252
Provider Name (Legal Business Name): RACHAEL POMATO CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N JEFFERSON ST STE 203
FREDERICK MD
21701-4865
US

IV. Provider business mailing address

10 N JEFFERSON ST STE 203
FREDERICK MD
21701-4865
US

V. Phone/Fax

Practice location:
  • Phone: 301-788-9561
  • Fax: 301-846-4915
Mailing address:
  • Phone: 301-788-9561
  • Fax: 301-846-4915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number17215
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: