MEDICARE: MRS. GLORIA LOU PILCZAK 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	15502	MA

General Provider Information

NPI Number	:	1518005883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GLORIA LOU PILCZAK RD, LDN

Provider Business Mailing Address
First Line	:	39 PROVIDENCE RD
Second Line	:
City	:	GRAFTON
State	:	MA
Zip	:	01519-1179
Country	:	US
Telephone Number	:	508-839-9969
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 PROVIDENCE RD
Second Line	:
City	:	GRAFTON
State	:	MA
Zip	:	01519-1179
Country	:	US
Telephone Number	:	508-839-9969
Fax Number	:	508-839-9969

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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