Active NPI
Marilyn Burton Kowalchuk, RD, SCD, LDN
- Registered Dietitian
- Charlotte, NC
National Provider Identifier
1235247297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- L000866
- Practice address
- 1001 Blythe Blvd Ste 300
Charlotte, NC 28203-5863 - Phone
- (704) 373-0212
- Fax
- (704) 373-1216
- NPI assigned
- Aug 29, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | L000866 | NC | Primary |
Addresses
Primary practice location
1001 Blythe Blvd Ste 300
Charlotte, NC 28203-5863
Mailing address
PO Box 60122
Charlotte, NC 28260-0122
Phone (704) 373-0212
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L000866 | NC | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Sanger Clinic PA | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233878400000",
"number": "1235247297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 60122",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282600122",
"telephone_number": "704-373-0212",
"fax_number": "704-373-1216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 BLYTHE BLVD STE 300",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282035863",
"telephone_number": "704-373-0212",
"fax_number": "704-373-1216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOWALCHUK",
"first_name": "MARILYN",
"middle_name": "BURTON",
"credential": "RD, SCD, LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-29",
"last_updated": "2009-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NC",
"license": "L000866",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.