MEDICARE: MIRIAM C DYSON RD, 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	DX5310	MD

General Provider Information

NPI Number	:	1558034330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM C DYSON RD, RDN

Provider Business Mailing Address
First Line	:	1036 SAINT NICHOLAS DR UNIT 101
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-4758
Country	:	US
Telephone Number	:	800-905-3261
Fax Number	:

Provider Business Practice Location Address
First Line	:	1036 SAINT NICHOLAS DR UNIT 101
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-4758
Country	:	US
Telephone Number	:	800-905-3261
Fax Number	:

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

Provider Enumeration Date	:	07/28/2021
Last Update Date	:	09/21/2021

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