Healthcare Provider Details

I. General information

NPI: 1881165975
Provider Name (Legal Business Name): KELSEY BAUMGARTEN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MAIN ST
NORTHAMPTON MA
01060-3109
US

IV. Provider business mailing address

128 TANNERY RD
WESTFIELD MA
01085-4841
US

V. Phone/Fax

Practice location:
  • Phone: 413-330-8167
  • Fax:
Mailing address:
  • Phone: 413-330-8167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4230
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: