Provider Demographics
NPI:1043246721
Name:DALLOSTA, REGINE BIRKENHAUER (RD)
Entity Type:Individual
Prefix:MRS
First Name:REGINE
Middle Name:BIRKENHAUER
Last Name:DALLOSTA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:REGINE
Other - Middle Name:CAROL
Other - Last Name:BIRKENHAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 758997
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:REGISTERED DIETITIAN
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0294
Practice Address - Country:US
Practice Address - Phone:804-828-0970
Practice Address - Fax:804-628-0921
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA610752133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA710000041Medicare ID - Type UnspecifiedMEDICARE
VAP62236Medicare UPIN