Provider Demographics
NPI:1124637673
Name:MEACHAM, JARED (PHD, RDN)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:MEACHAM
Suffix:
Gender:M
Credentials:PHD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10204 BRUNETT AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-2003
Mailing Address - Country:US
Mailing Address - Phone:918-805-0461
Mailing Address - Fax:
Practice Address - Street 1:10204 BRUNETT AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-2003
Practice Address - Country:US
Practice Address - Phone:918-805-0461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered