Basic Information
| Provider Information | |||||||||
| NPI: | 1225554603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | SCHMITT | ||||||||
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| Credential: | RD, LD, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64226 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6672141720 | ||||||||
| FaxNumber: | 4107066976 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 SHOREWAY DR | ||||||||
| Address2: | |||||||||
| City: | QUEENSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216581680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103288940 | ||||||||
| FaxNumber: | 4103288997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2017 | ||||||||
| LastUpdateDate: | 12/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 530866 | MD | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | D02029 | MD | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.