Provider Demographics
NPI:1326685595
Name:FLOCCO, MARIAN (RD)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:FLOCCO
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 1:12200 BROWNING PL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1743
Mailing Address - Country:US
Mailing Address - Phone:804-360-0544
Mailing Address - Fax:
Practice Address - Street 1:12200 BROWNING PL
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1743
Practice Address - Country:US
Practice Address - Phone:804-360-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA668548133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered