Provider Demographics
NPI:1932579471
Name:RAGLIN, MURIEL (LD, RD)
Entity Type:Individual
Prefix:
First Name:MURIEL
Middle Name:
Last Name:RAGLIN
Suffix:
Gender:F
Credentials:LD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-0379
Mailing Address - Country:US
Mailing Address - Phone:540-220-3438
Mailing Address - Fax:540-775-5335
Practice Address - Street 1:15195 KINGS MILL RD
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-2856
Practice Address - Country:US
Practice Address - Phone:540-220-3438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-27
Last Update Date:2015-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC133V00000X133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC058233600Medicaid