MEDICARE: S-GANGINIS, LLC

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	DX2769	MD
2	133V00000X	Registered Dietitian	DI100000482	DC

General Provider Information

NPI Number	:	1073883799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S-GANGINIS, LLC

Provider Business Mailing Address
First Line	:	8865 STANFORD BLVD
Second Line	:	SUITE 114
City	:	COLUMBIA
State	:	MD
Zip	:	21045-5420
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8865 STANFORD BLVD
Second Line	:	SUITE 114
City	:	COLUMBIA
State	:	MD
Zip	:	21045-5420
Country	:	US
Telephone Number	:	301-213-9472
Fax Number	:

Authorized Official
Title or Position	:	DIETITIAN
Name	:	SARAH GANGINIS
Credential	:	M.S., R.D., L.D.N.
Telephone Number	:	301-213-9472

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	01/12/2012

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