Provider Demographics
NPI:1366283558
Name:CARTER, CAMERON KEITH (RDN)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:KEITH
Last Name:CARTER
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17014 ASPEN LEAF DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3675
Mailing Address - Country:US
Mailing Address - Phone:301-785-3391
Mailing Address - Fax:
Practice Address - Street 1:1111 BENFIELD BLVD
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-3002
Practice Address - Country:US
Practice Address - Phone:410-975-5447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX6693133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered