Provider Demographics
NPI:1629437686
Name:ECKSTEIN, KAITLIN WILLIAMS (MPH, RD, LD)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:WILLIAMS
Last Name:ECKSTEIN
Suffix:
Gender:F
Credentials:MPH, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 IVY LN STE 410
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-6357
Mailing Address - Country:US
Mailing Address - Phone:301-474-2499
Mailing Address - Fax:
Practice Address - Street 1:6301 IVY LN STE 410
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-6357
Practice Address - Country:US
Practice Address - Phone:301-474-2499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3968133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered