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General NPI Number Information
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NPI Number | 1346429412
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Entity Type | Individual
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Provider Name | ANITA W. GATHOGO REGISTERED DIETITIAN
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Gender | Female
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 4744 RIDGE RD
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City | NOTTINGHAM
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State | MD
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Zip | 21236-3818
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Country | US
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Telephone | 410-440-1213
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Fax | 443-835-2502
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Provider Business Mailing Address
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Address Line | PO BOX 4784
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City | BALTIMORE
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State | MD
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Zip | 21211-0784
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Country | US
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Telephone | 410-440-1213
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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 | DX2478
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | DX2478
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number | DX2478
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License Number State | MD
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