MEDICARE: MARY-PATRICE RUOCCO MS,RD,LDN

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	145492	MA

General Provider Information

NPI Number	:	1417965773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY-PATRICE RUOCCO MS,RD,LDN

Provider Business Mailing Address
First Line	:	387 HIGH ST
Second Line	:
City	:	ROCHESTER
State	:	MA
Zip	:	02770-2227
Country	:	US
Telephone Number	:	508-295-4134
Fax Number	:	508-295-4134

Provider Business Practice Location Address
First Line	:	387 HIGH ST
Second Line	:
City	:	ROCHESTER
State	:	MA
Zip	:	02770-2227
Country	:	US
Telephone Number	:	508-295-4134
Fax Number	:	508-295-4134

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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