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NPI 1720906845

NPI 1720906845 : EDWARD FITZGERALD RD LLC : RALEIGH, NC

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General NPI Number Information
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    NPI Number           |    1720906845
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    Entity Type          |    Organization 
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    Legal Business Name  |    EDWARD FITZGERALD RD LLC 
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Dates
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    Enumeration Date     |    07/07/2026
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    Last Update Date     |    07/07/2026
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Provider Practice Location Address
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    Address Line         |    7304 MASSACHUSETTS CT 
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    City                 |    RALEIGH
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    State                |    NC
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    Zip                  |    27615-5639
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    Country              |    US
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    Telephone            |    919-279-0889
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    7304 MASSACHUSETTS CT 
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    City                 |    RALEIGH
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    State                |    NC
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    Zip                  |    27615-5639
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    Country              |    US
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    Telephone            |    919-279-0889
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    Fax                  |    
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Authorized Official
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    Title or Position    |    REGISTERED DIETITIAN
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    Name                 |     EDWARD  FITZGERALD 
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    Credential           |    RD, LDN
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    Telephone            |    919-279-0889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    133V00000X
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    Taxonomy Name        |    Registered Dietitian
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    License Number       |    
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    License Number State |    
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