Active NPI
Mary M Black
- Registered Dietitian
- Lumberton, NC
National Provider Identifier
1407855034
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- L000588
- Practice address
- 4300 Fayetteville Rd
Lumberton, NC 28358-2677 - Phone
- (910) 671-5830
- NPI assigned
- Jul 15, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | L000588 | NC | Primary |
Addresses
Primary practice location
4300 Fayetteville Rd
Lumberton, NC 28358-2677
Mailing address
300 W 27TH St
Attn: William J Gutekunst
Lumberton, NC 28358-3075
Phone (910) 671-5000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L000588 | NC | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeastern Regional Medical Center | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Hospitalist Physician
- Lumberton, NC
- NPI 1659531952
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1407855034",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 W 27TH ST",
"address_2": "ATTN: WILLIAM J GUTEKUNST",
"city": "LUMBERTON",
"state": "NC",
"postal_code": "283583075",
"telephone_number": "910-671-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4300 FAYETTEVILLE RD",
"city": "LUMBERTON",
"state": "NC",
"postal_code": "283582677",
"telephone_number": "910-671-5830"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "MARY",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-15",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NC",
"license": "L000588",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lumberton, NC
- Carmelita Tiburcio Bigelow, CLINICAL SOCIAL WORK
- Alissa Natalie Binford, PA-C
- Bio-Medical Applications of North Carolina, Inc.
- Bio-Medical Applications of North Carolina, Inc.
- BL Apothecary
- Andrea Suzette Blackburn, M.D.
- Lori Beck Blackley, DC
- Stephen C Blackmon, FNP
- Aubrey Blake, DPT
- Lisa Lowry Blake, CNM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.