Provider Demographics
NPI:1790233252
Name:POMATO, RACHAEL (CNS)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:POMATO
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N JEFFERSON ST STE 203
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4865
Mailing Address - Country:US
Mailing Address - Phone:301-788-9561
Mailing Address - Fax:301-846-4915
Practice Address - Street 1:10 N JEFFERSON ST STE 203
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4865
Practice Address - Country:US
Practice Address - Phone:301-788-9561
Practice Address - Fax:301-846-4915
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17215133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education