Basic Information
| Provider Information | |||||||||
| NPI: | 1508586215 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALDMAN | ||||||||
| FirstName: | CARLY | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | MS, RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1099 WINTERSON RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | LINTHICUM HEIGHTS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210902279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009053261 | ||||||||
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| Practice Location | |||||||||
| Address1: | 655 SOLOMONS ISLAND RD N STE 2021 | ||||||||
| Address2: | |||||||||
| City: | PRINCE FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206783915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109466648 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2022 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DX5751 | MD | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.