Provider Demographics
NPI:1427530781
Name:FULTZ, EMILY WAREHEIM (RDN, LDN)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:WAREHEIM
Last Name:FULTZ
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19900 MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MD
Mailing Address - Zip Code:21053-9421
Mailing Address - Country:US
Mailing Address - Phone:410-978-1414
Mailing Address - Fax:
Practice Address - Street 1:8388 COURT AVE STE 202
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4514
Practice Address - Country:US
Practice Address - Phone:410-978-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006915133V00000X
MDDX4226133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered