Healthcare Provider Details

I. General information

NPI: 1073977880
Provider Name (Legal Business Name): ABEER BADER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 STANIFORD ST 4TH FLOOR
BOSTON MA
02114-2517
US

IV. Provider business mailing address

50 STANIFORD ST STE 430
BOSTON MA
02114-2541
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4096
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: