Provider Demographics
NPI:1922808864
Name:MCCULLOCH, CLAUDIA ROSE (RDN)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:ROSE
Last Name:MCCULLOCH
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 1:213 MERCER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-3207
Mailing Address - Country:US
Mailing Address - Phone:806-470-4628
Mailing Address - Fax:
Practice Address - Street 1:213 MERCER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-3207
Practice Address - Country:US
Practice Address - Phone:806-470-4628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86117882133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered