Provider Demographics
NPI:1477166213
Name:MCDEVITT, MADELINE (RD)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:MCDEVITT
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 1:45 JIMMY LEE CT
Mailing Address - Street 2:
Mailing Address - City:MOHRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19541-9452
Mailing Address - Country:US
Mailing Address - Phone:610-858-6762
Mailing Address - Fax:
Practice Address - Street 1:45 JIMMY LEE CT
Practice Address - Street 2:
Practice Address - City:MOHRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19541-9452
Practice Address - Country:US
Practice Address - Phone:610-858-6762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-30
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86174490133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered