Provider Demographics
NPI:1346437852
Name:BUCHWALD, LISA ANN (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:BUCHWALD
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD,LD
Mailing Address - Street 1:44 W OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:RITTMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44270-1432
Mailing Address - Country:US
Mailing Address - Phone:716-997-3303
Mailing Address - Fax:
Practice Address - Street 1:1000 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2170
Practice Address - Country:US
Practice Address - Phone:716-997-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6059133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1346437852OtherNPI