Provider Demographics
NPI:1780998047
Name:RANDOLPH, ROSEMARIE (MS, RD, CGS)
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:MS, RD, CGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15013 ADELMAN RUN CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-3171
Mailing Address - Country:US
Mailing Address - Phone:405-812-1064
Mailing Address - Fax:
Practice Address - Street 1:15013 ADELMAN RUN CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-3171
Practice Address - Country:US
Practice Address - Phone:405-812-1064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered