MEDICARE: PAMELA RAND RD, LDN, CDOE, RYT

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	51	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	254296	OTHER	RI	BCBS
2	402791	OTHER	RI	BLUE CHIP
3	6300059	OTHER	RI	UHP

General Provider Information

NPI Number	:	1356416515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA RAND RD, LDN, CDOE, RYT

Provider Business Mailing Address
First Line	:	1167 KINGSTOWN RD UNIT 3
Second Line	:
City	:	PEACE DALE
State	:	RI
Zip	:	02879-7902
Country	:	US
Telephone Number	:	401-295-4003
Fax Number	:	401-783-4428

Provider Business Practice Location Address
First Line	:	1167 KINGSTOWN RD UNIT 3
Second Line	:
City	:	PEACE DALE
State	:	RI
Zip	:	02879-7902
Country	:	US
Telephone Number	:	401-295-4003
Fax Number	:	401-783-4428

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	03/26/2018

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