Provider Demographics
NPI:1669567228
Name:CHAMBERLAIN, MARI L (RD)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:L
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 MONTEVUE LN
Mailing Address - Street 2:AREA B, AFMSA/SGRTE
Mailing Address - City:FORT DETRICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-5058
Mailing Address - Country:US
Mailing Address - Phone:301-619-8601
Mailing Address - Fax:301-619-8638
Practice Address - Street 1:1270 MONTEVUE LN
Practice Address - Street 2:AREA B, AFMSA/SGRTE
Practice Address - City:FORT DETRICK
Practice Address - State:MD
Practice Address - Zip Code:21702-5058
Practice Address - Country:US
Practice Address - Phone:301-619-8601
Practice Address - Fax:301-619-8638
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered