MEDICARE: CATHERINE CONRAD 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
1	133V00000X	Registered Dietitian	999139	NJ
2	133V00000X	Registered Dietitian	LDN00680	RI

General Provider Information

NPI Number	:	1962706499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE CONRAD R.D.

Provider Business Mailing Address
First Line	:	8 GLEN HILL DR
Second Line	:
City	:	SAUNDERSTOWN
State	:	RI
Zip	:	02874-1918
Country	:	US
Telephone Number	:	732-690-0717
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 GLEN HILL DR
Second Line	:
City	:	SAUNDERSTOWN
State	:	RI
Zip	:	02874-1918
Country	:	US
Telephone Number	:	732-690-0717
Fax Number	:

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

Provider Enumeration Date	:	12/23/2010
Last Update Date	:	04/29/2014

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