Provider Demographics
NPI:1972631547
Name:MCGINNIS, ADRIAN RICHARD (RD)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:RICHARD
Last Name:MCGINNIS
Suffix:
Gender:M
Credentials:RD
Other - Prefix:MR
Other - First Name:ADRIAN
Other - Middle Name:RICHARD
Other - Last Name:MCGINNIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS RD LD CDE
Mailing Address - Street 1:4483 WOODRUM LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25313-2333
Mailing Address - Country:US
Mailing Address - Phone:304-744-4088
Mailing Address - Fax:304-766-3796
Practice Address - Street 1:4506 MACCORKLE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309
Practice Address - Country:US
Practice Address - Phone:304-766-3431
Practice Address - Fax:304-766-3796
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV360WV133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP47509Medicare UPIN
WVMT00721Medicare ID - Type Unspecified