Provider Demographics
NPI:1649086844
Name:BAUGH, MARIAH LARYN (RD, LDN)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:LARYN
Last Name:BAUGH
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 1:1688 S AVON AVE
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8496
Mailing Address - Country:US
Mailing Address - Phone:317-627-5582
Mailing Address - Fax:
Practice Address - Street 1:1688 S AVON AVE
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8496
Practice Address - Country:US
Practice Address - Phone:317-627-5582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86276225133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered