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NPI Code Detail

MEDICARE: MS. TRACY ROSE GOLDBERG-GROSS R.D.

MEDICARE: MS. TRACY ROSE GOLDBERG-GROSS R.D.
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 Dietitian

General Provider Information

NPI Number : 1376584441
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TRACY ROSE GOLDBERG-GROSS R.D.
Provider Business Mailing Address
First Line : 6420 CLAYTON RD
Second Line :
City : RICHMOND HEIGHTS
State : MO
Zip : 63117-1811
Country : US
Telephone Number : 314-768-8891
Fax Number :
Provider Business Practice Location Address
First Line : 6420 CLAYTON RD
Second Line :
City : RICHMOND HEIGHTS
State : MO
Zip : 63117-1811
Country : US
Telephone Number : 314-768-8891
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2006
Last Update Date : 09/21/2016

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