Provider Demographics
NPI:1710122411
Name:RUSCH, MOLLY LYNN (RDN)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:LYNN
Last Name:RUSCH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600-B ABRUZZI DRIVE
Mailing Address - Street 2:PMB #120
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619
Mailing Address - Country:US
Mailing Address - Phone:410-279-0621
Mailing Address - Fax:
Practice Address - Street 1:120 MCKENNEY LN
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-2139
Practice Address - Country:US
Practice Address - Phone:410-279-0621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD02275133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered