Provider Demographics
NPI:1760839989
Name:FUSTER, JILL (MS, RD, LDN)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:FUSTER
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:MERCHANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LDN
Mailing Address - Street 1:11300 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 503
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3003
Mailing Address - Country:US
Mailing Address - Phone:301-652-8720
Mailing Address - Fax:301-984-3332
Practice Address - Street 1:11300 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 503
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3003
Practice Address - Country:US
Practice Address - Phone:301-652-8720
Practice Address - Fax:301-984-3332
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01933133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered