MEDICARE: CARLY RAE MCGEEHAN RD, 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	LD7960	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LD7960	OTHER	OH	THE OHIO BOARD OF DIETETICS
2	86041140	OTHER		COMMISSION ON DIETETIC REGISTRATION - ACADEMY OF NUTRITION AND DIETETICS

General Provider Information

NPI Number	:	1780126847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY RAE MCGEEHAN RD, LD

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

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

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

Provider Enumeration Date	:	11/07/2016
Last Update Date	:	08/12/2020

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