MEDICARE: ABBY VAN DER VEER R.D.

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		SC

General Provider Information

NPI Number	:	1538178314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBY VAN DER VEER R.D.

Provider Business Mailing Address
First Line	:	4229 EISENHOWER DR
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18020-8945
Country	:	US
Telephone Number	:	843-693-4420
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 ELMS CENTRE RD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9844
Country	:	US
Telephone Number	:	843-572-7727
Fax Number	:

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	02/24/2010

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