Healthcare Provider Details

I. General information

NPI: 1942456942
Provider Name (Legal Business Name): AMY GOLDSMITH R.D, L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY MASTRO R.D, L.D.

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 TOLL HOUSE AVE
FREDERICK MD
21701-4519
US

IV. Provider business mailing address

810 TOLL HOUSE AVE
FREDERICK MD
21701-4519
US

V. Phone/Fax

Practice location:
  • Phone: 301-580-0008
  • Fax: 301-624-4172
Mailing address:
  • Phone: 301-580-0008
  • Fax: 301-624-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number893706
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: