Provider Demographics
NPI:1508586215
Name:WALDMAN, CARLY JANE (MS, RD)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:JANE
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 WINTERSON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2279
Mailing Address - Country:US
Mailing Address - Phone:800-905-3261
Mailing Address - Fax:
Practice Address - Street 1:655 SOLOMONS ISLAND RD N STE 2021
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3915
Practice Address - Country:US
Practice Address - Phone:410-946-6648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5751133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered