Provider Demographics
NPI:1649842428
Name:MUKHAR, REEM SALAMEH (RD CLE)
Entity type:Individual
Prefix:
First Name:REEM
Middle Name:SALAMEH
Last Name:MUKHAR
Suffix:
Gender:F
Credentials:RD CLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-8080
Mailing Address - Country:US
Mailing Address - Phone:410-598-4336
Mailing Address - Fax:
Practice Address - Street 1:17 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:MD
Practice Address - Zip Code:21769-8080
Practice Address - Country:US
Practice Address - Phone:410-598-4336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4618133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered