1578082905 NPI number — MARGARET ROBERTS BOVA MS, RD, LDN

Table of content: MARGARET ROBERTS BOVA MS, RD, LDN (NPI 1578082905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578082905 NPI number — MARGARET ROBERTS BOVA MS, RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOVA
Provider First Name:
MARGARET
Provider Middle Name:
ROBERTS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBERTS
Provider Other First Name:
MARGARET
Provider Other Middle Name:
FAYE
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:
1578082905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4207 LAKE BOONE TRL STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27607-6685
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-784-7874
Provider Business Mailing Address Fax Number:
919-784-2801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4207 LAKE BOONE TRAIL
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-784-7874
Provider Business Practice Location Address Fax Number:
919-784-2801
Provider Enumeration Date:
09/18/2017

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:  L005220 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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