Provider Demographics
NPI:1457759532
Name:WOLFORD, BETSEY (DT)
Entity type:Individual
Prefix:
First Name:BETSEY
Middle Name:
Last Name:WOLFORD
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 PERSIMMONTREE CT
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2649
Mailing Address - Country:US
Mailing Address - Phone:410-721-7418
Mailing Address - Fax:
Practice Address - Street 1:1305 PERSIMMONTREE CT
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2649
Practice Address - Country:US
Practice Address - Phone:410-721-7418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00408133V00000X
DCD1559133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered