Robert Brandon Wallace, RD
Dietitian, Registered in Bethesda, MD. Individual provider (NPI-1).
NPI number1053018366
StatusActive
Last updated in NPPESDec 12, 2025
Details
- NPI
- 1053018366
- Entity type
- Individual (NPI-1)
- Name
- Robert Brandon Wallace
- Credential
- RD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 8, 2023
- Certification date
- Dec 12, 2025
- Last updated
- Dec 12, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 133V00000X | Dietitian, Registered | 86376928 | – | Yes |
Practice location
4494 Palmer Rd NBethesda, MD 20814
Phone 301-400-0586
Mailing address
4494 Palmer Rd NBethesda, MD 20814
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