Healthcare Provider Details

I. General information

NPI: 1164756847
Provider Name (Legal Business Name): ERIN K REDDING RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE GI/NUTRITION DEPT. HUNNEWELL BASEMENT
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE GI/NUTRITION DEPT. HUNNEWELL BASEMENT
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-5204
  • Fax: 617-730-0496
Mailing address:
  • Phone: 617-355-5204
  • Fax: 617-730-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number2647
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: