MEDICARE: ALLISON ALDERMAN RD, LDN, MS

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	1092595	FL

General Provider Information

NPI Number	:	1891153490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON ALDERMAN RD, LDN, MS

Provider Business Mailing Address
First Line	:	1106 NEW JERSEY AVE
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-3824
Country	:	US
Telephone Number	:	904-535-7411
Fax Number	:

Provider Business Practice Location Address
First Line	:	5046 W CHESTER PIKE
Second Line	:
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-2802
Country	:	US
Telephone Number	:	610-715-4685
Fax Number	:

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

Provider Enumeration Date	:	02/10/2016
Last Update Date	:	04/02/2019

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