Provider Demographics
NPI:1598823635
Name:MCARTHUR, MARY J (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:J
Last Name:MCARTHUR
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MONTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2912
Mailing Address - Country:US
Mailing Address - Phone:330-723-1968
Mailing Address - Fax:
Practice Address - Street 1:260 MONTVIEW DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2912
Practice Address - Country:US
Practice Address - Phone:330-723-1968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1798133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMCMT71311Medicare ID - Type Unspecified