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NPI Code Detail

MEDICARE: MEGAN WINE RD

MEDICARE:   MEGAN  WINE  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
1133V00000XRegistered Dietitian86076751VA

General Provider Information

NPI Number : 1376140574
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN WINE RD
Provider Business Mailing Address
First Line : 6627 W BROAD ST STE 400
Second Line :
City : RICHMOND
State : VA
Zip : 23230-1733
Country : US
Telephone Number : 804-774-4550
Fax Number :
Provider Business Practice Location Address
First Line : 6627 W BROAD ST STE 400
Second Line :
City : RICHMOND
State : VA
Zip : 23230-1733
Country : US
Telephone Number : 804-774-4550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2020
Last Update Date : 10/01/2020

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Directions to “ MEGAN WINE RD” Practice Location

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