MEDICARE: MOLLY HITESMAN 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	86044942	VA

General Provider Information

NPI Number	:	1194670638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY HITESMAN RD

Provider Business Mailing Address
First Line	:	4320 RESERVOIR LN
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23234-3537
Country	:	US
Telephone Number	:	570-337-8923
Fax Number	:

Provider Business Practice Location Address
First Line	:	4320 RESERVOIR LN
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23234-3537
Country	:	US
Telephone Number	:	570-337-8923
Fax Number	:

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

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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