MEDICARE: KATHRYN DWYER

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	DN007559	PA

General Provider Information

NPI Number	:	1275463341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN DWYER

Provider Business Mailing Address
First Line	:	703 BURBRIDGE RD
Second Line	:
City	:	HATBORO
State	:	PA
Zip	:	19040-4523
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 BURBRIDGE RD
Second Line	:
City	:	HATBORO
State	:	PA
Zip	:	19040-4523
Country	:	US
Telephone Number	:	215-284-5037
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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