Provider Demographics
NPI:1467701482
Name:MCINTYRE, TRACY JEAN (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:JEAN
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16220 FREDERICK RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4016
Mailing Address - Country:US
Mailing Address - Phone:240-724-6781
Mailing Address - Fax:888-607-7117
Practice Address - Street 1:16220 FREDERICK RD
Practice Address - Street 2:SUITE 120
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4016
Practice Address - Country:US
Practice Address - Phone:240-724-6781
Practice Address - Fax:888-607-7117
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDO1403133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered