Provider Demographics
NPI:1639411168
Name:PERRY, MARY L (RD CDE)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:L
Last Name:PERRY
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3149 RIDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-7207
Mailing Address - Country:US
Mailing Address - Phone:434-974-1564
Mailing Address - Fax:434-243-4522
Practice Address - Street 1:2955 IVY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-9353
Practice Address - Country:US
Practice Address - Phone:434-243-4791
Practice Address - Fax:434-243-4522
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered