MEDICARE: MARY KATHRYN EDWARDS RD

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	074.0134384	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497460554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KATHRYN EDWARDS RD

Provider Business Mailing Address
First Line	:	90 FOSTER FARM RD
Second Line	:
City	:	STOWE
State	:	VT
Zip	:	05672-5073
Country	:	US
Telephone Number	:	706-338-7948
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 S WINOOSKI AVE STE 2C
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05401-3969
Country	:	US
Telephone Number	:	802-861-1200
Fax Number	:

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

Provider Enumeration Date	:	01/23/2023
Last Update Date	:	01/23/2023

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