Provider Demographics
NPI:1790748283
Name:PLOG, HUNTER GREEN (RD, LDN)
Entity Type:Individual
Prefix:
First Name:HUNTER
Middle Name:GREEN
Last Name:PLOG
Suffix:
Gender:M
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAELS
Mailing Address - State:MD
Mailing Address - Zip Code:21663-2960
Mailing Address - Country:US
Mailing Address - Phone:443-786-2051
Mailing Address - Fax:
Practice Address - Street 1:1019 MONROE AVE
Practice Address - Street 2:
Practice Address - City:SAINT MICHAELS
Practice Address - State:MD
Practice Address - Zip Code:21663-2960
Practice Address - Country:US
Practice Address - Phone:443-786-2051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD02221133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1790748283OtherK3071638
K307I638Medicare ID - Type Unspecified