Provider Demographics
NPI:1659594828
Name:SMITH, MELVIN DENNIS (RD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:DENNIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6636 CHRISTY ACRES CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-7473
Mailing Address - Country:US
Mailing Address - Phone:301-504-6369
Mailing Address - Fax:301-504-6409
Practice Address - Street 1:10301 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2326
Practice Address - Country:US
Practice Address - Phone:301-504-6369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
661509133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered