Provider Demographics
NPI:1619750213
Name:CONRAN, MARY B (RDN, LD-N, CDN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:CONRAN
Suffix:
Gender:F
Credentials:RDN, LD-N, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12220 CHATTANOOGA PLZ # 274
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4865
Mailing Address - Country:US
Mailing Address - Phone:203-214-9719
Mailing Address - Fax:
Practice Address - Street 1:2727 ENTERPRISE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-6341
Practice Address - Country:US
Practice Address - Phone:804-536-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered