Provider Demographics
NPI:1295850550
Name:GAMMARINO, MARILYN MONROE (RD, LD, CDE)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:MONROE
Last Name:GAMMARINO
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 1:3 HIDDEN PONDS CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2213
Mailing Address - Country:US
Mailing Address - Phone:301-978-9773
Mailing Address - Fax:301-978-9773
Practice Address - Street 1:3 HIDDEN PONDS CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2213
Practice Address - Country:US
Practice Address - Phone:301-978-9773
Practice Address - Fax:301-978-9773
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00131133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD37167OtherUNITED HEALTH CARE #
MDD00131OtherPROF DIETETIC LICENSE
MD5811216-001OtherCIGNA HEALTH CARE #
DCDI346OtherPROF DIETETIC LICENSE