MEDICARE: MARIE J SEEGER 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	548	SC

General Provider Information

NPI Number	:	1720560311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE J SEEGER RD

Provider Business Mailing Address
First Line	:	1546 GARDENIA RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-5212
Country	:	US
Telephone Number	:	843-324-4137
Fax Number	:

Provider Business Practice Location Address
First Line	:	1546 GARDENIA RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-5212
Country	:	US
Telephone Number	:	843-324-4137
Fax Number	:

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

Provider Enumeration Date	:	08/30/2018
Last Update Date	:	08/30/2018

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