Provider Demographics
NPI:1578775615
Name:RO, LINDA C (RD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:RO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:718 E 3RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-2915
Mailing Address - Country:US
Mailing Address - Phone:330-332-9986
Mailing Address - Fax:330-332-8899
Practice Address - Street 1:718 E 3RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2915
Practice Address - Country:US
Practice Address - Phone:330-332-9986
Practice Address - Fax:330-332-8899
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHLD235133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHROMT01351Medicare ID - Type Unspecified