Provider Demographics
NPI:1811464373
Name:VANGELDER, MITCHELL (RD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:VANGELDER
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8794 SILER CITY GLENDON RD
Mailing Address - Street 2:
Mailing Address - City:BEAR CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:27207-9064
Mailing Address - Country:US
Mailing Address - Phone:919-819-4850
Mailing Address - Fax:
Practice Address - Street 1:8794 SILER CITY GLENDON RD
Practice Address - Street 2:
Practice Address - City:BEAR CREEK
Practice Address - State:NC
Practice Address - Zip Code:27207-9064
Practice Address - Country:US
Practice Address - Phone:919-819-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA137941Medicaid