Healthcare Provider Details

I. General information

NPI: 1326638214
Provider Name (Legal Business Name): LEIGHA MORIARTY RD/RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 DOUGLAS STREET SUITE 500
DURHAM NC
27705
US

IV. Provider business mailing address

PO BOX 13289
DURHAM NC
27709-3289
US

V. Phone/Fax

Practice location:
  • Phone: 919-908-9730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL006319
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: