MEDICARE: MRS. AMY S RUGGIERO RD LD

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	133VN1006X	Metabolic Nutrition Registered Dietitian	LD5258	OH

General Provider Information

NPI Number	:	1275542979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY S RUGGIERO RD LD

Provider Business Mailing Address
First Line	:	6601 BROCK ST
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-1610
Country	:	US
Telephone Number	:	614-336-8294
Fax Number	:

Provider Business Practice Location Address
First Line	:	3363 TREMONT RD
Second Line	:	SUITE 104A
City	:	COLUMBUS
State	:	OH
Zip	:	43221-2110
Country	:	US
Telephone Number	:	614-451-2868
Fax Number	:	614-451-2868

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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