MEDICARE: EMILY KATE SIMON RD, LDN

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	2294	MA

General Provider Information

NPI Number	:	1114147816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY KATE SIMON RD, LDN

Provider Business Mailing Address
First Line	:	1222 CAMBRIDGE ST
Second Line	:	APT 1
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-1375
Country	:	US
Telephone Number	:	774-292-9101
Fax Number	:

Provider Business Practice Location Address
First Line	:	1222 CAMBRIDGE ST
Second Line	:	APT 1
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-1375
Country	:	US
Telephone Number	:	774-292-9101
Fax Number	:

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	11/20/2007

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