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NPI Code Detail

MEDICARE: MRS. THERESA M MCGROARTY MS RD LDN CDE

MEDICARE: MRS. THERESA M MCGROARTY MS RD LDN CDE
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
1133V00000XRegistered DietitianDN001097PA

General Provider Information

NPI Number : 1285896381
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. THERESA M MCGROARTY MS RD LDN CDE
Provider Business Mailing Address
First Line : 5201 HAVERFORD AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19139-1401
Country : US
Telephone Number : 215-471-2763
Fax Number : 215-472-6092
Provider Business Practice Location Address
First Line : 5201 HAVERFORD AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19139-1401
Country : US
Telephone Number : 215-471-2763
Fax Number : 215-472-6092
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2008
Last Update Date : 03/30/2014

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