MEDICARE: VIRGINIA HART TAYLOR RD LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1422	SC

General Provider Information

NPI Number	:	1124773452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA HART TAYLOR RD LDN

Provider Business Mailing Address
First Line	:	125 GREENWOOD DR APT 3402
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29928-4524
Country	:	US
Telephone Number	:	843-816-6285
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 GREENWOOD DR APT 3402
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29928-4524
Country	:	US
Telephone Number	:	843-816-6285
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2022
Last Update Date	:	02/15/2022

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