Provider Demographics
NPI:1497921647
Name:TROUTNER, ANDREA CICCONE (RD, LD, LDN, CDCES)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:CICCONE
Last Name:TROUTNER
Suffix:
Gender:F
Credentials:RD, LD, LDN, CDCES
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:MARY
Other - Last Name:CICCONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19101 ARTESIAN CT
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2428
Mailing Address - Country:US
Mailing Address - Phone:301-466-0611
Mailing Address - Fax:888-570-4119
Practice Address - Street 1:19101 ARTESIAN COURT
Practice Address - Street 2:
Practice Address - City:DERWOOD
Practice Address - State:MD
Practice Address - Zip Code:20855
Practice Address - Country:US
Practice Address - Phone:301-466-0611
Practice Address - Fax:301-990-8226
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01420133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDAN83-0001OtherGROUP HOSPITALIZATION AND MEDICAL SERVICES, INC AND BLUE CHOICE, INC