Healthcare Provider Details

I. General information

NPI: 1548474356
Provider Name (Legal Business Name): ELIZABETH T HARLIN RD CDE LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 RESNIK RD
PLYMOUTH MA
02360
US

IV. Provider business mailing address

30 RESNIK RD
PLYMOUTH MA
02360
US

V. Phone/Fax

Practice location:
  • Phone: 508-747-9775
  • Fax: 508-746-4208
Mailing address:
  • Phone: 508-747-9775
  • Fax: 508-746-4208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1402
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: