MEDICARE: MITCHELL VANGELDER 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

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	:	1811464373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL VANGELDER RD

Provider Business Mailing Address
First Line	:	8794 SILER CITY GLENDON RD
Second Line	:
City	:	BEAR CREEK
State	:	NC
Zip	:	27207-9064
Country	:	US
Telephone Number	:	919-819-4850
Fax Number	:

Provider Business Practice Location Address
First Line	:	8794 SILER CITY GLENDON RD
Second Line	:
City	:	BEAR CREEK
State	:	NC
Zip	:	27207-9064
Country	:	US
Telephone Number	:	919-819-4850
Fax Number	:

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

Provider Enumeration Date	:	11/01/2018
Last Update Date	:	07/17/2024

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