Provider Demographics
NPI:1659496925
Name:BELHAM, VIRGINIA DALE (RD REGISTERED DIETIT)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:DALE
Last Name:BELHAM
Suffix:
Gender:F
Credentials:RD REGISTERED DIETIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12356 WINDANCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503
Mailing Address - Country:US
Mailing Address - Phone:228-424-3631
Mailing Address - Fax:
Practice Address - Street 1:149 DRINKWATER BLVD
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39521-2790
Practice Address - Country:US
Practice Address - Phone:228-467-8730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD0430133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered