Provider Demographics
NPI:1629534003
Name:MELTON, LAUREN (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MELTON
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:GUY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:214 PRINCE GEORGE ST # F
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1658
Mailing Address - Country:US
Mailing Address - Phone:478-550-0132
Mailing Address - Fax:
Practice Address - Street 1:6700 RACE TRACK RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-3009
Practice Address - Country:US
Practice Address - Phone:301-383-2581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4624133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered