Healthcare Provider Details

I. General information

NPI: 1134678071
Provider Name (Legal Business Name): MEREDITH ANNE CAPITO R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 UNIVERSITY TOWN CENTRE DR
MORGANTOWN WV
26501-2421
US

IV. Provider business mailing address

830 PENNSYLVANIA AVE SUITE 103
CHARLESTON WV
25302-3302
US

V. Phone/Fax

Practice location:
  • Phone: 855-988-2273
  • Fax: 304-285-7372
Mailing address:
  • Phone: 304-388-1552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1051
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: