Provider Demographics
NPI:1750861613
Name:TABB, KATHLEEN (RD)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:TABB
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7219 HANOVER PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2021
Mailing Address - Country:US
Mailing Address - Phone:301-474-2499
Mailing Address - Fax:
Practice Address - Street 1:7219 HANOVER PKWY STE D
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2021
Practice Address - Country:US
Practice Address - Phone:301-474-2499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4495133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered