MEDICARE: MELANIE SESERMAN 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	835643	MA

General Provider Information

NPI Number	:	1578893582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE SESERMAN RD

Provider Business Mailing Address
First Line	:	54 CASTLE ST
Second Line	:
City	:	GT BARRINGTON
State	:	MA
Zip	:	01230-1502
Country	:	US
Telephone Number	:	413-528-9311
Fax Number	:	413-528-2863

Provider Business Practice Location Address
First Line	:	29 LEWIS AVE
Second Line	:	FAIRVIEW HOSPITAL FOURTH FLOOR
City	:	GT BARRINGTON
State	:	MA
Zip	:	01230-1713
Country	:	US
Telephone Number	:	413-528-8580
Fax Number	:	413-528-2863

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

Provider Enumeration Date	:	01/14/2010
Last Update Date	:	01/14/2010

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