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General NPI Number Information
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NPI Number | 1144500208
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Entity Type | Individual
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Provider Name | DIANE A VIZTHUM R.D.
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Gender | Female
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 09/02/2015
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Provider Practice Location Address
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Address Line | 600 N WOLFE ST NUTRITION CLINIC, HALSTED 153
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City | BALTIMORE
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State | MD
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Zip | 21287-1900
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Country | US
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Telephone | 410-955-6716
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Fax |
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Provider Business Mailing Address
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Address Line | 2360 W JOPPA ROAD STE 210
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City | LUTHERVILLE
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State | MD
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Zip | 21093
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Country | US
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Telephone | 410-614-3372
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DX3229
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License Number State | MD
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