Most Relevant Information
Provider Data
| NPI Number: | 1003312315 |
| Provider Name: | COURTNEY BASCOM |
| Entity Type: | Individual |
| Taxonomy Code: | 133V00000X |
| Specialty: | Dietitian, Registered |
| License Number: | 86077676 |
Most Important Dates
| Enumeration Date: | 04/04/2018 |
| Last Updated: | 04/04/2018 |
Provider Practice Location
1300 JEFFERSON PARK AVE FL 4
CHARLOTTESVILLE
VA
229033363
Practice Location Phone/Fax
| Phone: | 4349245367 |
| Fax: |
Provider Mailing Location
361 1ST ST N
CHARLOTTESVILLE
VA
229025004
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |