Provider Demographics
NPI:1629284948
Name:PEPPER, MARGERY REESE (PHD, RD)
Entity Type:Individual
Prefix:DR
First Name:MARGERY
Middle Name:REESE
Last Name:PEPPER
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:MS
Other - First Name:M.
Other - Middle Name:REESE
Other - Last Name:PEPPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, RD
Mailing Address - Street 1:1613 S HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4420
Mailing Address - Country:US
Mailing Address - Phone:512-799-2229
Mailing Address - Fax:410-706-5030
Practice Address - Street 1:1613 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4420
Practice Address - Country:US
Practice Address - Phone:512-799-2229
Practice Address - Fax:410-706-5090
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07730133V00000X, 133VN1004X
MDDX3149133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180921201Medicaid