Provider Demographics
NPI:1154136224
Name:GANOE, DAMIAN J (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:DAMIAN
Middle Name:J
Last Name:GANOE
Suffix:
Gender:M
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13321 US 15 HWY 501
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-5034
Mailing Address - Country:US
Mailing Address - Phone:919-413-1094
Mailing Address - Fax:
Practice Address - Street 1:13321 US 15 HWY 501
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-5034
Practice Address - Country:US
Practice Address - Phone:919-413-1094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL008380133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered