Provider Demographics
NPI:1528531407
Name:LAUTZ, MEGAN E (MS, RDN)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:E
Last Name:LAUTZ
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ELIZABETH
Other - Last Name:SOLLOWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:579 BALTIMORE ANNAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3809
Mailing Address - Country:US
Mailing Address - Phone:410-975-5447
Mailing Address - Fax:
Practice Address - Street 1:579 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3809
Practice Address - Country:US
Practice Address - Phone:410-975-5447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3862133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered