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General NPI Number Information
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NPI Number | 1306816798
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Entity Type | Individual
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Provider Name | DENISE BARRA RD
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Gender | Female
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 04/07/2009
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Provider Practice Location Address
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Address Line | 26 CITY HALL MALL
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City | MEDFORD
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State | MA
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Zip | 02155-4754
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Country | US
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Telephone | 617-629-6444
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Fax |
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Provider Business Mailing Address
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Address Line | 147 MILK ST PROVIDER ENROLLMENT 9TH FLOOR
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City | BOSTON
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State | MA
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Zip | 02109-4806
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Country | US
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Telephone | 617-559-8051
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 549
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License Number State | MA
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