MEDICARE: MARY RAFFETTO

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	DN005135	PA

General Provider Information

NPI Number	:	1174070700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY RAFFETTO

Provider Business Mailing Address
First Line	:	933 W WHITEHALL RD APT 2
Second Line	:
City	:	STATE COLLEGE
State	:	PA
Zip	:	16801-2904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2907 PLEASANT VALLEY BLVD.
Second Line	:
City	:	ALTOONA
State	:	PA
Zip	:	16602
Country	:	US
Telephone Number	:	814-943-8164
Fax Number	:

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	04/07/2026

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Directions to “ MARY RAFFETTO ” Practice Location

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