MEDICARE: EMILY A PETERS LD

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	LD7192	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508225590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY A PETERS LD

Provider Business Mailing Address
First Line	:	5202 BETHEL REED PARK
Second Line	:	SUITE 100
City	:	COLUMBUS
State	:	OH
Zip	:	43220-1818
Country	:	US
Telephone Number	:	614-447-9495
Fax Number	:	614-447-9163

Provider Business Practice Location Address
First Line	:	5202 BETHEL REED PARK
Second Line	:	SUITE 100
City	:	COLUMBUS
State	:	OH
Zip	:	43220-1818
Country	:	US
Telephone Number	:	614-447-9495
Fax Number	:	614-447-9163

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

Provider Enumeration Date	:	02/18/2016
Last Update Date	:	02/09/2017

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Directions to “ EMILY A PETERS LD” Practice Location

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