Provider Demographics
NPI:1841693454
Name:WEIR, MARY K (RD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:WEIR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:K
Other - Last Name:WEIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:1218 GERRADS CROSS
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9151
Mailing Address - Country:US
Mailing Address - Phone:585-507-0408
Mailing Address - Fax:
Practice Address - Street 1:1218 GERRADS CROSS
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-9151
Practice Address - Country:US
Practice Address - Phone:585-507-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-28
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8122376133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered