Basic Information
Provider Information
NPI: 1003000324
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RATH
FirstName: MARY
MiddleName: COLLEEN
NamePrefix: MS.
NameSuffix:  
Credential: R.D., L.D., CNSC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9500 EUCLID AVE
Address2: M17
City: CLEVELAND
State: OH
PostalCode: 441950001
CountryCode: US
TelephoneNumber: 2164446986
FaxNumber:  
Practice Location
Address1: 9500 EUCLID AVE
Address2: M17
City: CLEVELAND
State: OH
PostalCode: 441950001
CountryCode: US
TelephoneNumber: 2164446986
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/29/2007
LastUpdateDate: 04/23/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000XLD.6014OHY Dietary & Nutritional Service ProvidersDietitian, Registered 

No ID Information.


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