Anne T Thacker, LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LD 5190 Issued in OH

Practice address

4614 Prospect Ave
Ste 325
Cleveland, OH 44103-4377

Phone

(216) 777-2136

NPI assigned

Dec 31, 2009

Last updated

Sep 4, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Anne T Dicello Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Agm Physical Therapy, LLC

  • Specialist
  • Mentor, OH
  • NPI 1689691776
  NPD (past)
• Lake Hospital System, Inc

  dba Lake Health Urgent Care and Walk In Clinic

  • Urgent Care Clinic/Center
  • Chardon, OH
  • NPI 1689634966
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1262217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599177600000",
    "number": "1467782185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9930 JOHNNYCAKE RIDGE RD STE 6B",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440606766",
            "telephone_number": "440-357-6677",
            "fax_number": "440-357-6681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4614 PROSPECT AVE",
            "address_2": "STE 325",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441034377",
            "telephone_number": "216-777-2136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THACKER",
        "first_name": "ANNE",
        "middle_name": "T",
        "credential": "LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-31",
        "last_updated": "2020-09-04",
        "certification_date": "2020-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OH",
            "license": "LD 5190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNE",
            "last_name": "DICELLO",
            "middle_name": "T",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Emily Tewksbury
• Thabet & Haddadeen LLC (Angel Dental Care)
• Thabet DDS LLC (Angel Dental Care)
• Walid R Thabet, DDS
• Kinxian Thach, RN
• Heather Thacker
• Holly L Thacker, MD
• Laura Huber Thacker
• Annie Thai, MD
• Jacqueline Thai

• Registered Dietitian in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Registered Dietitian in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.