Provider Demographics
NPI:1679927255
Name:SCHILTZ, GREGORY (MPH, RD, LDN)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:SCHILTZ
Suffix:
Gender:M
Credentials:MPH, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S PEAK DR
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2472
Mailing Address - Country:US
Mailing Address - Phone:847-707-3684
Mailing Address - Fax:
Practice Address - Street 1:5324 MCFARLAND RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6865
Practice Address - Country:US
Practice Address - Phone:919-354-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004864133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered