MEDICARE: MR. MATTHEW RICHARDSON WHIPPLE RDN, LDN

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	DN006189	PA

General Provider Information

NPI Number	:	1982105748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW RICHARDSON WHIPPLE RDN, LDN

Provider Business Mailing Address
First Line	:	2346 GERRITT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-4107
Country	:	US
Telephone Number	:	985-232-3435
Fax Number	:

Provider Business Practice Location Address
First Line	:	2346 GERRITT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-4107
Country	:	US
Telephone Number	:	985-232-3435
Fax Number	:

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

Provider Enumeration Date	:	02/26/2018
Last Update Date	:	02/26/2018

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