Provider Demographics
NPI:1063715159
Name:MOELLER, MEREDITH ROSE (RD, LDN)
Entity type:Individual
Prefix:MISS
First Name:MEREDITH
Middle Name:ROSE
Last Name:MOELLER
Suffix:
Gender:
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 SANDY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4838
Mailing Address - Country:US
Mailing Address - Phone:302-593-1163
Mailing Address - Fax:
Practice Address - Street 1:9400 SANDY CREEK RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4838
Practice Address - Country:US
Practice Address - Phone:302-593-1163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDN-0000417133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric