Healthcare Provider Details

I. General information

NPI: 1144182742
Provider Name (Legal Business Name): BENJAMIN O'DONNELL RD, LDN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 PATRICK MURPHY DR APT 11
MORGANTON NC
28655-4691
US

IV. Provider business mailing address

166 PATRICK MURPHY DR APT 11
MORGANTON NC
28655-4691
US

V. Phone/Fax

Practice location:
  • Phone: 336-244-1584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL007971
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: