MEDICARE: MRS. CATHERINE A CHINCOLA RD,LDN,CDE

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	007732	NY

General Provider Information

NPI Number	:	1740548049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHERINE A CHINCOLA RD,LDN,CDE

Provider Business Mailing Address
First Line	:	PO BOX 1025
Second Line	:
City	:	BRODHEADSVILLE
State	:	PA
Zip	:	18322-1025
Country	:	US
Telephone Number	:	610-681-3300
Fax Number	:	610-681-3343

Provider Business Practice Location Address
First Line	:	3065 ROUTE 50
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2960
Country	:	US
Telephone Number	:	518-886-5880
Fax Number	:	610-681-3343

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

Provider Enumeration Date	:	04/25/2012
Last Update Date	:	03/03/2025

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