MEDICARE: ASHLEY JUDSON RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	10563	OH

General Provider Information

NPI Number	:	1043566375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY JUDSON RD

Provider Business Mailing Address
First Line	:	1653 GLOBE ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-1474
Country	:	US
Telephone Number	:	440-452-9294
Fax Number	:

Provider Business Practice Location Address
First Line	:	1653 GLOBE ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-1474
Country	:	US
Telephone Number	:	440-452-9294
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	09/08/2014

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