Healthcare Provider Details

I. General information

NPI: 1932435088
Provider Name (Legal Business Name): MAGGIE M MEYER RD LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12904 BRUSHWOOD TER
POTOMAC MD
20854-1006
US

IV. Provider business mailing address

12904 BRUSHWOOD TER
POTOMAC MD
20854-1006
US

V. Phone/Fax

Practice location:
  • Phone: 301-947-6594
  • Fax:
Mailing address:
  • Phone: 301-947-6594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP6772
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX2541
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: