Provider Demographics
NPI:1700350964
Name:GOSCH, CHRISTINE (BS DTR)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:GOSCH
Suffix:
Gender:F
Credentials:BS DTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7171 FOUNTAIN ROCK WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1485
Mailing Address - Country:US
Mailing Address - Phone:301-672-3735
Mailing Address - Fax:
Practice Address - Street 1:7171 FOUNTAIN ROCK WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1485
Practice Address - Country:US
Practice Address - Phone:301-672-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered