Provider Demographics
NPI:1821858341
Name:DEREMEIK, ANNIE (RD, CSP, LDN)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:DEREMEIK
Suffix:
Gender:F
Credentials:RD, CSP, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 VALLEY COURT RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6412
Mailing Address - Country:US
Mailing Address - Phone:410-598-7090
Mailing Address - Fax:
Practice Address - Street 1:302 VALLEY COURT RD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6412
Practice Address - Country:US
Practice Address - Phone:410-598-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2453133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered