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General NPI Number Information
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NPI Number | 1831126366
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Entity Type | Individual
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Provider Name | RONALD RAYMOND SANDRETH JR. RD,LD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | LOUIS A. JOHNSON VAMC 1 MEDICAL CENTER DRIVE
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City | CLARKSBURG
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State | WV
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Zip | 26301
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Country | US
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Telephone | 304-626-7730
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Fax |
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Provider Business Mailing Address
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Address Line | 1 MEDICAL CENTER DR LOUIS A JOHNSON VAMC
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City | CLARKSBURG
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State | WV
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Zip | 26301
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Country | US
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Telephone | 304-626-7730
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 186
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License Number State | WV
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