Provider Demographics
NPI:1528197290
Name:VODICKA, PAMELLA KAY (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:PAMELLA
Middle Name:KAY
Last Name:VODICKA
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 1:4853 CORDELL AVE
Mailing Address - Street 2:APARTMENT 1214
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-7015
Mailing Address - Country:US
Mailing Address - Phone:301-215-9141
Mailing Address - Fax:
Practice Address - Street 1:WALTER REED ARMY MEDICAL CENTER - PEDIATRICS
Practice Address - Street 2:6900 GEORGIA AVE, NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-5001
Practice Address - Country:US
Practice Address - Phone:202-782-5500
Practice Address - Fax:202-782-8136
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2593133V00000X
DC133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered