Provider Demographics
NPI:1598965626
Name:BROWN, MARY D (MS, RD, LDN)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 SPRINGMIST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3281
Mailing Address - Country:US
Mailing Address - Phone:704-999-0880
Mailing Address - Fax:877-385-9026
Practice Address - Street 1:2102 SOUTH BLVD
Practice Address - Street 2:#100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5384
Practice Address - Country:US
Practice Address - Phone:704-999-0880
Practice Address - Fax:877-385-9026
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 133NN1002X, 133VN1004X
NCL003052133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric