MEDICARE: ELIZABETH J. CLAYDON RD

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	LD1587	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PO0299764	OTHER	OH	RRMEDICARE

General Provider Information

NPI Number	:	1538117759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH J. CLAYDON RD

Provider Business Mailing Address
First Line	:	2830 VICTORY PKWY
Second Line	:	STE 310
City	:	CINCINNATI
State	:	OH
Zip	:	45206-3700
Country	:	US
Telephone Number	:	513-245-3444
Fax Number	:	513-245-3449

Provider Business Practice Location Address
First Line	:	3120 BURNET AVE
Second Line	:	STE 306
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3091
Country	:	US
Telephone Number	:	513-475-8200
Fax Number	:	513-475-8201

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	03/12/2008

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Directions to “ ELIZABETH J. CLAYDON RD” Practice Location

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