Healthcare Provider Details

I. General information

NPI: 1629437686
Provider Name (Legal Business Name): KAITLIN WILLIAMS ECKSTEIN MPH, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 IVY LN STE 410
GREENBELT MD
20770-6357
US

IV. Provider business mailing address

6301 IVY LN STE 410
GREENBELT MD
20770-6357
US

V. Phone/Fax

Practice location:
  • Phone: 301-474-2499
  • Fax:
Mailing address:
  • Phone: 301-474-2499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX3968
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: