MEDICARE: EAT WITH ERIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3897011000	OTHER	PA	INDIVIDUAL HMO
2	3897011000	OTHER	PA	IBC INDIVIDUAL PPO

General Provider Information

NPI Number	:	1275128886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAT WITH ERIN

Provider Business Mailing Address
First Line	:	113 MILARD LN
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-5101
Country	:	US
Telephone Number	:	610-247-4785
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 W EAGLE RD STE 132
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-2244
Country	:	US
Telephone Number	:	610-247-4785
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERIN CAROULIS
Credential	:	RD, LDN
Telephone Number	:	610-247-4785

Provider Enumeration Date	:	03/05/2021
Last Update Date	:	03/05/2021

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Directions to “EAT WITH ERIN ” Practice Location

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