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NPI Code Detail

MEDICARE: MS. DIANE R DUBE RDN, LDN, CDCES

MEDICARE: MS. DIANE R DUBE RDN, LDN, CDCES
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
1133V00000XRegistered Dietitian748MA

General Provider Information

NPI Number : 1538161112
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DIANE R DUBE RDN, LDN, CDCES
Provider Business Mailing Address
First Line : P.O. BOX 8465
Second Line :
City : SALEM
State : MA
Zip : 01971-8465
Country : US
Telephone Number : 617-240-6383
Fax Number : 978-745-7982
Provider Business Practice Location Address
First Line : 250 PARADISE ROAD
Second Line :
City : SWAMPSCOTT
State : MA
Zip : 01907
Country : US
Telephone Number : 617-240-6383
Fax Number : 978-745-7982
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2005
Last Update Date : 07/22/2020

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