Provider Demographics
NPI:1447606256
Name:SARRY, LOUIS R (LDN, CNS)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:R
Last Name:SARRY
Suffix:
Gender:M
Credentials:LDN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12315 WAKE FOREST RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1508
Mailing Address - Country:US
Mailing Address - Phone:240-232-6447
Mailing Address - Fax:
Practice Address - Street 1:12315 WAKE FOREST RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1508
Practice Address - Country:US
Practice Address - Phone:240-232-6447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3857133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist