Provider Demographics
NPI:1962833822
Name:GOLDSMITH, ANNE HERZOG (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:HERZOG
Last Name:GOLDSMITH
Suffix:
Gender:F
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 1:5500 LONDONDERRY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3730
Mailing Address - Country:US
Mailing Address - Phone:617-308-3766
Mailing Address - Fax:
Practice Address - Street 1:10130 MALLARD CREEK RD
Practice Address - Street 2:300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-6000
Practice Address - Country:US
Practice Address - Phone:704-549-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004301133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered