Provider Demographics
NPI:1306930847
Name:RATCHFORD-DEMKOSKY, MARIE T (MS, RD, LDN,CDE)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:T
Last Name:RATCHFORD-DEMKOSKY
Suffix:
Gender:F
Credentials:MS, RD, LDN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MAIN ST
Mailing Address - Street 2:SUITE L4
Mailing Address - City:BLAKELY
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1241
Mailing Address - Country:US
Mailing Address - Phone:570-604-6677
Mailing Address - Fax:570-307-4220
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:SUITE L4
Practice Address - City:BLAKELY
Practice Address - State:PA
Practice Address - Zip Code:18447-1241
Practice Address - Country:US
Practice Address - Phone:570-604-6677
Practice Address - Fax:570-307-4220
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000285133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered