Provider Demographics
NPI:1720329543
Name:CLARKE, GENEVIEVE (RDN, LDN, CDCES)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:RDN, LDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7202 RAINBOW LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-2979
Mailing Address - Country:US
Mailing Address - Phone:781-223-0746
Mailing Address - Fax:
Practice Address - Street 1:7202 RAINBOW LN
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-2979
Practice Address - Country:US
Practice Address - Phone:781-223-0746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
1044258OtherCOMMISSION ON DIETETIC REGISTRATION
DCDI100000694OtherDISTRICT OF COLUMBIA BOARD OF DIETETICS AND NUTRITION
DX3311OtherMARYLAND STATE BOARD OF DIETETIC PRACTICE