Provider Demographics
NPI:1902018021
Name:LAMB, MARA V (RD,LD,CDE)
Entity Type:Individual
Prefix:MRS
First Name:MARA
Middle Name:V
Last Name:LAMB
Suffix:
Gender:F
Credentials:RD,LD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HERITAGE RD.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3305
Mailing Address - Country:US
Mailing Address - Phone:937-435-4355
Mailing Address - Fax:937-434-0102
Practice Address - Street 1:2717 MIAMISBURG CENTERVILLE RD STE 207
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3797
Practice Address - Country:US
Practice Address - Phone:937-435-4355
Practice Address - Fax:937-434-0102
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL400133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH63-00034OtherUNITED HEALTH CARE
OHLAMT00711Medicare ID - Type Unspecified