Healthcare Provider Details

I. General information

NPI: 1578148789
Provider Name (Legal Business Name): CATHERINE ABIGAIL MATHEWS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBY MATHEWS RD

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9109 STONY POINT DR
RICHMOND VA
23235-1979
US

IV. Provider business mailing address

3113 W MARSHALL ST APT 408
RICHMOND VA
23230-4741
US

V. Phone/Fax

Practice location:
  • Phone: 804-827-0045
  • Fax:
Mailing address:
  • Phone: 757-282-8529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86105682
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: