MEDICARE: MR. JOHN HARTNETT LAMBERSON RD, CDE

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	L001879	NC

General Provider Information

NPI Number	:	1497979884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN HARTNETT LAMBERSON RD, CDE

Provider Business Mailing Address
First Line	:	1908 N ROAD ST
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-9343
Country	:	US
Telephone Number	:	252-335-9355
Fax Number	:	844-965-9381

Provider Business Practice Location Address
First Line	:	1908 N ROAD ST
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-9343
Country	:	US
Telephone Number	:	252-335-9355
Fax Number	:	252-338-4190

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	09/25/2024

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