MEDICARE: LISA HUGH 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	DO2284	MD

General Provider Information

NPI Number	:	1043585607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA HUGH RD

Provider Business Mailing Address
First Line	:	4560 CRAIN HWY
Second Line	:	STE 12
City	:	WHITE PLAINS
State	:	MD
Zip	:	20695-3084
Country	:	US
Telephone Number	:	240-210-9725
Fax Number	:	240-366-1161

Provider Business Practice Location Address
First Line	:	4560 CRAIN HWY
Second Line	:	STE 12
City	:	WHITE PLAINS
State	:	MD
Zip	:	20695-3084
Country	:	US
Telephone Number	:	240-210-9725
Fax Number	:	240-366-1161

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

Provider Enumeration Date	:	03/15/2012
Last Update Date	:	04/15/2017

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Directions to “ LISA HUGH RD” Practice Location

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