Provider Demographics
NPI:1578183620
Name:HALL, RYAN D (DCN,CNS, LDN)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:D
Last Name:HALL
Suffix:
Gender:
Credentials:DCN,CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2071 AFTON MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:VA
Mailing Address - Zip Code:22920-2308
Mailing Address - Country:US
Mailing Address - Phone:434-326-8635
Mailing Address - Fax:
Practice Address - Street 1:2071 AFTON MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:VA
Practice Address - Zip Code:22920-2308
Practice Address - Country:US
Practice Address - Phone:434-326-8635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-19
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA17913133N00000X
MDDX5865133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist