Healthcare Provider Details

I. General information

NPI: 1043246721
Provider Name (Legal Business Name): REGINE BIRKENHAUER DALLOSTA R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REGINE CAROL BIRKENHAUER R.D.

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST REGISTERED DIETITIAN
RICHMOND VA
23298-0294
US

IV. Provider business mailing address

PO BOX 758997
BALTIMORE MD
21275-0001
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-0970
  • Fax: 804-628-0921
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number610752
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: