Provider Demographics
NPI:1134142375
Name:KIRBY, CAITLIN HOSMER (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:CAITLIN
Middle Name:HOSMER
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:MS
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:HOSMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:90 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3945
Mailing Address - Country:US
Mailing Address - Phone:617-732-6054
Mailing Address - Fax:617-666-2582
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-6054
Practice Address - Fax:617-732-7024
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1331133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAHOMT0379Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER