Provider Demographics
NPI:1861821431
Name:AMATANGELO, MARIETTA (RDN/LDN)
Entity Type:Individual
Prefix:
First Name:MARIETTA
Middle Name:
Last Name:AMATANGELO
Suffix:
Gender:F
Credentials:RDN/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11532 SENECA FOREST CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4342
Mailing Address - Country:US
Mailing Address - Phone:240-426-9509
Mailing Address - Fax:
Practice Address - Street 1:927 RUSSELL AVE STE B
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-6222
Practice Address - Country:US
Practice Address - Phone:240-426-9509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD02264133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered