Provider Demographics
NPI:1780357558
Name:RUFAEL, MEGAN (MS, CNS, LDN)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:RUFAEL
Suffix:
Gender:F
Credentials:MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 AUGUSTA WAY
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-8976
Mailing Address - Country:US
Mailing Address - Phone:949-929-2185
Mailing Address - Fax:
Practice Address - Street 1:4407 AUGUSTA WAY
Practice Address - Street 2:
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128-8976
Practice Address - Country:US
Practice Address - Phone:949-929-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18221133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist