Provider Demographics
NPI:1720601834
Name:MARKO, HEATHER (MS, RD, CSSD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MARKO
Suffix:
Gender:F
Credentials:MS, RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 CARY STREET RD APT 1
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2530
Mailing Address - Country:US
Mailing Address - Phone:518-817-2320
Mailing Address - Fax:
Practice Address - Street 1:4104 CARY STREET RD APT 1
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2530
Practice Address - Country:US
Practice Address - Phone:518-817-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics