Healthcare Provider Details

I. General information

NPI: 1497856249
Provider Name (Legal Business Name): MARY ELLEN WARD RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NUTRITION AND FOOD SERVICE (120) VAMC
PERRY POINT MD
21902
US

IV. Provider business mailing address

55 SURREY LANE
RISING SUN MD
21911
US

V. Phone/Fax

Practice location:
  • Phone: 410-642-2411
  • Fax: 410-642-1849
Mailing address:
  • Phone: 410-642-2411
  • Fax: 410-642-1849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number689044
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: