Provider Demographics
NPI:1134478266
Name:DICKIE, MARY ANN (RD)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:DICKIE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 NEWARK ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-3166
Mailing Address - Country:US
Mailing Address - Phone:202-297-3370
Mailing Address - Fax:202-362-3122
Practice Address - Street 1:3418 NEWARK ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3166
Practice Address - Country:US
Practice Address - Phone:202-297-3370
Practice Address - Fax:202-362-3122
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI140133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered