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General NPI Number Information
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NPI Number | 1154013696
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Entity Type | Individual
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Provider Name | PARKER CHARLES LANE RD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2023
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 1200 E BROAD ST
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City | RICHMOND
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State | VA
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Zip | 23298-5025
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Country | US
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Telephone | 804-828-0970
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Fax | 804-628-0204
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Provider Business Mailing Address
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Address Line | PO BOX 19171
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City | PHILADELPHIA
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State | PA
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Zip | 19171-8997
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number | LDN6548
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86170171
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License Number State | VA
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