Provider Demographics
NPI:1194194118
Name:STEM, RICHARD (RD, LDN)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:STEM
Suffix:
Gender:M
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4713 DELTA LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-7013
Mailing Address - Country:US
Mailing Address - Phone:919-308-9397
Mailing Address - Fax:
Practice Address - Street 1:804 SALEM WOODS DR STE 202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3343
Practice Address - Country:US
Practice Address - Phone:919-322-0213
Practice Address - Fax:704-972-0639
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004728133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered