MEDICARE: MADELINE RAE GOTTFRIED MDN, RD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LD.10162	OH

General Provider Information

NPI Number	:	1003775974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE RAE GOTTFRIED MDN, RD, LD

Provider Business Mailing Address
First Line	:	26218 N WOODLAND RD
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-1745
Country	:	US
Telephone Number	:	216-577-1552
Fax Number	:

Provider Business Practice Location Address
First Line	:	10138 NANFORD RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-1653
Country	:	US
Telephone Number	:	216-577-1552
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/16/2026

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