IndividualActive
Anzor Modzgvreschvili, RD
NPI 1245866862 · Gerontological Nutrition Registered Dietitian · Detroit, MI
Provider details
- NPI number
- 1245866862
- Entity type
- Individual
- Primary specialty
- Gerontological Nutrition Registered DietitianDietary & Nutritional Service Providers
- Credential
- RD
- Sex
- Male
- Sole proprietor
- No
Mailing address
6201 Greenleigh Ave
Middle River, MD 21220-2004
Registry dates
- Enumerated
- 2020-03-15
- Last updated
- 2022-09-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.