MEDICARE: SARA ELIZABETH MASKER RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DX6754	MD

General Provider Information

NPI Number	:	1063269033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA ELIZABETH MASKER RDN

Provider Business Mailing Address
First Line	:	410 LOCKERMAN ST
Second Line	:
City	:	DENTON
State	:	MD
Zip	:	21629-1048
Country	:	US
Telephone Number	:	410-479-3075
Fax Number	:	833-914-0407

Provider Business Practice Location Address
First Line	:	410 LOCKERMAN ST
Second Line	:
City	:	DENTON
State	:	MD
Zip	:	21629-1048
Country	:	US
Telephone Number	:	410-479-3075
Fax Number	:	833-914-0407

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	12/11/2024

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