Provider Demographics
NPI:1376769935
Name:RIGGINS, MARY E
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:RIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10439 TROUTDALE HWY
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:VA
Mailing Address - Zip Code:24378-2259
Mailing Address - Country:US
Mailing Address - Phone:276-782-1287
Mailing Address - Fax:
Practice Address - Street 1:565 RADIO HILL RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-6587
Practice Address - Country:US
Practice Address - Phone:276-782-1287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP79322Medicare UPIN