Provider Demographics
NPI:1538178314
Name:VAN DER VEER, ABBY (RD)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:VAN DER VEER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8945
Mailing Address - Country:US
Mailing Address - Phone:843-693-4420
Mailing Address - Fax:
Practice Address - Street 1:2550 ELMS CENTRE RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9844
Practice Address - Country:US
Practice Address - Phone:843-572-7727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ335035281Medicare PIN
SCQ335037555Medicare PIN
SCQ335035277Medicare PIN
SCQ335037498Medicare PIN
SCQ335037499Medicare PIN