Provider Demographics
NPI:1174125769
Name:DAW, MARIA B (RDN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:B
Last Name:DAW
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 BRAMBLE DR
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-2776
Mailing Address - Country:US
Mailing Address - Phone:330-730-9343
Mailing Address - Fax:
Practice Address - Street 1:4275 BRAMBLE DR
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-2776
Practice Address - Country:US
Practice Address - Phone:330-730-9343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09128133V00000X
MDDX5123133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered