Provider Demographics
NPI:1174892707
Name:STOLBERG, DANIEL ALEXANDER (RD)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ALEXANDER
Last Name:STOLBERG
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:NUTRITION CLINIC
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL STREET
Practice Address - Street 2:NUTRITION CLINIC
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0510
Practice Address - Country:US
Practice Address - Phone:804-828-0970
Practice Address - Fax:804-628-0204
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered