Provider Demographics
NPI:1083220586
Name:GOEBEL, DANIEL (RD, LDN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GOEBEL
Suffix:
Gender:M
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 PRINCE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02113-1826
Mailing Address - Country:US
Mailing Address - Phone:360-441-0349
Mailing Address - Fax:
Practice Address - Street 1:31 SAINT JAMES AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-4101
Practice Address - Country:US
Practice Address - Phone:360-441-0349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5065133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered