MEDICARE: ADELAIDE M. PUELZL-QUINN RD

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	1375	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	680078	OTHER	MA	TUFTS HEALTH PLAN
2	AA16258	OTHER	MA	HARVARD PILGRIM
3	0033089	OTHER	MA	NEIGHBORHOOD HEALTH PLAN
4	LD0159	OTHER	MA	BLUE CROSS

General Provider Information

NPI Number	:	1245203157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADELAIDE M. PUELZL-QUINN RD

Provider Business Mailing Address
First Line	:	1 JOSLIN PL
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02215-5306
Country	:	US
Telephone Number	:	617-732-2603
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 JOSLIN PL
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02215-5306
Country	:	US
Telephone Number	:	617-732-2603
Fax Number	:

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	12/12/2011

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