MEDICARE: MARITA LOYOLA 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	LD.2530	OH

General Provider Information

NPI Number	:	1821429127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARITA LOYOLA LD

Provider Business Mailing Address
First Line	:	2600 SIXTH ST SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44710-1702
Country	:	US
Telephone Number	:	330-452-9911
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 TUSCARAWAS ST W
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-4603
Country	:	US
Telephone Number	:	330-452-9911
Fax Number	:

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

Provider Enumeration Date	:	12/12/2013
Last Update Date	:	12/12/2013

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Directions to “ MARITA LOYOLA LD” Practice Location

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