Provider Demographics
NPI:1346429412
Name:GATHOGO, ANITA W (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:W
Last Name:GATHOGO
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:W
Other - Last Name:GATHAGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS RD/LDN
Mailing Address - Street 1:PO BOX 4784
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-0784
Mailing Address - Country:US
Mailing Address - Phone:410-440-1213
Mailing Address - Fax:
Practice Address - Street 1:4744 RIDGE RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-3818
Practice Address - Country:US
Practice Address - Phone:410-440-1213
Practice Address - Fax:443-835-2502
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2478133V00000X, 133VN1006X, 133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic