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NPI Code Detail

MEDICARE: LISA MARIE WONG RD, LD

MEDICARE: LISA MARIE WONG 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
1133V00000XRegistered DietitianLD3989OH

General Provider Information

NPI Number : 1881104610
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MARIE WONG RD, LD
Provider Business Mailing Address
First Line : 648 TAYLOR RD
Second Line :
City : GAHANNA
State : OH
Zip : 43230-3202
Country : US
Telephone Number : 614-864-7225
Fax Number : 614-626-8335
Provider Business Practice Location Address
First Line : 648 TAYLOR RD
Second Line :
City : GAHANNA
State : OH
Zip : 43230-3202
Country : US
Telephone Number : 614-864-7225
Fax Number : 614-626-8335
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2017
Last Update Date : 09/07/2023

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Directions to “ LISA MARIE WONG RD, LD” Practice Location

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