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NPI Code Detail

MEDICARE: MRS. DIANE H. HANNON R.D.

MEDICARE: MRS. DIANE H. HANNON R.D.
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 Dietitian1653MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LD0169OTHERMABCBSMA LDN ANCILLARY PROV

General Provider Information

NPI Number : 1538162938
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DIANE H. HANNON R.D.
Provider Business Mailing Address
First Line : 129 NIMROD DR
Second Line :
City : CONCORD
State : MA
Zip : 01742-1646
Country : US
Telephone Number : 978-369-0035
Fax Number : 978-369-0035
Provider Business Practice Location Address
First Line : 2194 MAIN ST
Second Line : OFC 6
City : CONCORD
State : MA
Zip : 01742-3829
Country : US
Telephone Number : 978-505-5953
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 10/30/2008

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