Provider Demographics
NPI:1639708993
Name:PRITCHARD, TRACY LEIGH (MS, CNS, LDN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEIGH
Last Name:PRITCHARD
Suffix:
Gender:F
Credentials:MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2514
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-8514
Mailing Address - Country:US
Mailing Address - Phone:301-690-8404
Mailing Address - Fax:
Practice Address - Street 1:23140 MOAKLEY ST STE 6
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2931
Practice Address - Country:US
Practice Address - Phone:301-690-8404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4397133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist