Provider Demographics
NPI:1942456942
Name:GOLDSMITH, AMY (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:MASTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:6325 MEANDERING WOODS CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4955
Mailing Address - Country:US
Mailing Address - Phone:301-580-0008
Mailing Address - Fax:301-624-4172
Practice Address - Street 1:6325 MEANDERING WOODS CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4955
Practice Address - Country:US
Practice Address - Phone:301-580-0008
Practice Address - Fax:301-624-4172
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA893706133VN1006X, 133VN1005X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric