Healthcare Provider Details

I. General information

NPI: 1144346016
Provider Name (Legal Business Name): LORRAINE S CASTALDO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CAMBRIDGE ST MGH CAPD UNIT SUITE 504
BOSTON MA
02114-2783
US

IV. Provider business mailing address

165 CAMBRIDGE ST MGH CAPD UNIT SUITE 504
BOSTON MA
02114-2783
US

V. Phone/Fax

Practice location:
  • Phone: 617-720-1317
  • Fax:
Mailing address:
  • Phone: 617-720-1317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number910
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: