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NPI Code Detail

MEDICARE: MARA ROSE SANSEVERO REGISTERED DIETITIAN

MEDICARE: MARA ROSE SANSEVERO REGISTERED DIETITIAN
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 Dietitian2140MA

General Provider Information

NPI Number : 1295951143
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARA ROSE SANSEVERO REGISTERED DIETITIAN
Provider Business Mailing Address
First Line : 301 S HUNTINGTON AVE
Second Line : BRIGHAM & WOMEN'S ADVANCED PRIMARY CARE ASSOCIATES, SH
City : JAMAICA PLAIN
State : MA
Zip : 02130-4807
Country : US
Telephone Number : 857-307-3364
Fax Number :
Provider Business Practice Location Address
First Line : 301 S HUNTINGTON AVE
Second Line : BRIGHAM & WOMEN'S ADVANCED PRIMARY CARE ASSOCIATES, SH
City : JAMAICA PLAIN
State : MA
Zip : 02130-4807
Country : US
Telephone Number : 857-307-3364
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 08/04/2011

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Directions to “ MARA ROSE SANSEVERO REGISTERED DIETITIAN” Practice Location

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