1780126847 NPI number — CARLY RAE MCGEEHAN RD, LD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780126847 NPI number — CARLY RAE MCGEEHAN RD, LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGEEHAN
Provider First Name:
CARLY
Provider Middle Name:
RAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD, LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YANNI
Provider Other First Name:
CARLY
Provider Other Middle Name:
RAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780126847
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5202 BETHEL REED PARK STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43220-1818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-447-9495
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5202 BETHEL REED PARK STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43220-1818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-447-9495
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  LD7960 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LD7960 . This is a "THE OHIO BOARD OF DIETETICS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 86041140 . This is a "COMMISSION ON DIETETIC REGISTRATION - ACADEMY OF NUTRITION AND DIETETICS" identifier . This identifiers is of the category "OTHER".




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