Provider Demographics
NPI:1205209889
Name:COLCHIN, MARIA (RD LDN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:COLCHIN
Suffix:
Gender:F
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 1:147 VERA RD STE A
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-3756
Mailing Address - Country:US
Mailing Address - Phone:803-575-0468
Mailing Address - Fax:803-728-3224
Practice Address - Street 1:147 VERA RD STE A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3756
Practice Address - Country:US
Practice Address - Phone:803-575-0468
Practice Address - Fax:803-728-3224
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1041133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered