Provider Demographics
NPI:1467717462
Name:MITCHELL, FAYE BERGER (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:FAYE
Middle Name:BERGER
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12829 LAMP POST LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2322
Mailing Address - Country:US
Mailing Address - Phone:301-309-9395
Mailing Address - Fax:301-309-0620
Practice Address - Street 1:7910 WOODMONT AVE
Practice Address - Street 2:SUITE 1102
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3002
Practice Address - Country:US
Practice Address - Phone:301-309-9395
Practice Address - Fax:301-309-0620
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00040133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered