Provider Demographics
NPI:1225554603
Name:KING, MARY SCHMITT (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SCHMITT
Last Name:KING
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64226
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4226
Mailing Address - Country:US
Mailing Address - Phone:667-214-1720
Mailing Address - Fax:410-706-6976
Practice Address - Street 1:125 SHOREWAY DR
Practice Address - Street 2:
Practice Address - City:QUEENSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21658-1680
Practice Address - Country:US
Practice Address - Phone:410-328-8940
Practice Address - Fax:410-328-8997
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD530866133V00000X
MDD02029133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered