MEDICARE: MIRA BELLA COLEMAN RDN

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	5701-NU-NU	MA
2	133V00000X	Registered Dietitian	LDN5701	MA

General Provider Information

NPI Number	:	1255043428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRA BELLA COLEMAN RDN

Provider Business Mailing Address
First Line	:	85 MIDDLESEX TPKE STE 3110
Second Line	:
City	:	BURLINGTON
State	:	MA
Zip	:	01803-5380
Country	:	US
Telephone Number	:	781-744-7351
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 MIDDLESEX TPKE STE 3110
Second Line	:
City	:	BURLINGTON
State	:	MA
Zip	:	01803-5380
Country	:	US
Telephone Number	:	781-744-7351
Fax Number	:	781-744-7966

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

Provider Enumeration Date	:	12/20/2022
Last Update Date	:	03/07/2023

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