Provider Demographics
NPI:1124452826
Name:MAINES, EMILY R (RD, LD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:MAINES
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:RUTH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 758997
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-8997
Mailing Address - Country:US
Mailing Address - Phone:804-261-0626
Mailing Address - Fax:804-662-7302
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:DEPT. OF CLINICAL NUTRITION SERVICES
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-828-0907
Practice Address - Fax:804-628-0204
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1067901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered