Healthcare Provider Details

I. General information

NPI: 1043853542
Provider Name (Legal Business Name): ELAINE MCCALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 JEFFERSON PARK AVE
CHARLOTTESVILLE VA
22903
US

IV. Provider business mailing address

4997 CUB CREEK RD
ROSELAND VA
22967-2421
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-5959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: