MEDICARE: EMILY WAREHEIM FULTZ RDN, LDN

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	DN006915	PA
2	133V00000X	Registered Dietitian	DX4226	MD

General Provider Information

NPI Number	:	1427530781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY WAREHEIM FULTZ RDN, LDN

Provider Business Mailing Address
First Line	:	19900 MIDDLETOWN RD
Second Line	:
City	:	FREELAND
State	:	MD
Zip	:	21053-9421
Country	:	US
Telephone Number	:	410-978-1414
Fax Number	:

Provider Business Practice Location Address
First Line	:	8388 COURT AVE STE 202
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4514
Country	:	US
Telephone Number	:	410-978-1414
Fax Number	:

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

Provider Enumeration Date	:	09/04/2018
Last Update Date	:	05/14/2021

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