NPIMap

Individual provider Active NPI

Mary Sistrunk, RD

  • Registered Dietitian
  • Waldorf, MD
National Provider Identifier
1811083884
Registry record updated Apr 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
D01770 Issued in MD
Practice address
3510 Old Washington Rd
Suite #100
Waldorf, MD 20602-3233
Phone
(301) 609-5200
Fax
(301) 609-5220
NPI assigned
Oct 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X D01770 MD Primary

Addresses

Primary practice location

3510 Old Washington Rd
Suite #100
Waldorf, MD 20602-3233

Mailing address

3510 Old Washington Rd
Suite #100
Waldorf, MD 20602-3233
Phone (301) 609-5200

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)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Civista Medical Center, Inc. Past Accepting new patients
Civista Medical Center Inc Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209340800000",
    "number": "1811083884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3510 OLD WASHINGTON RD",
            "address_2": "SUITE #100",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023233",
            "telephone_number": "301-609-5200",
            "fax_number": "301-609-5220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3510 OLD WASHINGTON RD",
            "address_2": "SUITE #100",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023233",
            "telephone_number": "301-609-5200",
            "fax_number": "301-609-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISTRUNK",
        "first_name": "MARY",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2008-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MD",
            "license": "D01770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.