Provider Demographics
NPI:1780865014
Name:CAMPBELL, ROYA ANVAR (RD,LDN)
Entity type:Individual
Prefix:MRS
First Name:ROYA
Middle Name:ANVAR
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5113 BIRCHBARK LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-4916
Mailing Address - Country:US
Mailing Address - Phone:704-577-8416
Mailing Address - Fax:704-248-7561
Practice Address - Street 1:1801 E. 5TH STREET
Practice Address - Street 2:SUITE 213
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227
Practice Address - Country:US
Practice Address - Phone:704-577-8416
Practice Address - Fax:704-248-7561
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000855133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14192OtherBCBS PROVIDER #