Provider Demographics
NPI:1093908519
Name:TAYLOR, ELIZABETH J (RD, LD, CDE)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:42 WESTON ST
Mailing Address - Street 2:WALTHAM DIABETES CENTER SUITE 8
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-7756
Mailing Address - Country:US
Mailing Address - Phone:781-647-7220
Mailing Address - Fax:781-894-1101
Practice Address - Street 1:42 WESTON ST
Practice Address - Street 2:WALTHAM DIABETES CENTER SUITE 8
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-7756
Practice Address - Country:US
Practice Address - Phone:781-647-7220
Practice Address - Fax:781-894-1101
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA720205133V00000X
1744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No1744R1102XOther Service ProvidersSpecialistResearch Study