Healthcare Provider Details

I. General information

NPI: 1184665788
Provider Name (Legal Business Name): JAMIE SUTTON DEEM R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 MEDICAL CAMPUS RD SUITE 108
HAGERSTOWN MD
21742-6700
US

IV. Provider business mailing address

11110 MEDICAL CAMPUS RD SUITE 108
HAGERSTOWN MD
21742-6700
US

V. Phone/Fax

Practice location:
  • Phone: 301-714-4041
  • Fax: 301-714-4351
Mailing address:
  • Phone: 301-714-4041
  • Fax: 301-714-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberDX2474
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: