MEDICARE: MRS. CAROLYN LANE GARVEY 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	LD2422	OH

General Provider Information

NPI Number	:	1861839466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN LANE GARVEY RD LD

Provider Business Mailing Address
First Line	:	10685 CARNEGIE AVE BLDG X20
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-3018
Country	:	US
Telephone Number	:	216-636-9525
Fax Number	:	216-444-3282

Provider Business Practice Location Address
First Line	:	10685 CARNEGIE AVE BLDG X20
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-3018
Country	:	US
Telephone Number	:	216-636-9525
Fax Number	:	216-444-3282

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

Provider Enumeration Date	:	05/23/2013
Last Update Date	:	04/08/2020

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