Provider Demographics
NPI:1144243395
Name:BERMUDEZ, PAMELA D (RD,LDN,CDE)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:D
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:RD,LDN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LEEWARD LN
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748-3726
Mailing Address - Country:US
Mailing Address - Phone:774-526-1586
Mailing Address - Fax:508-996-4783
Practice Address - Street 1:3 LEEWARD LN
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02748-3726
Practice Address - Country:US
Practice Address - Phone:774-526-1586
Practice Address - Fax:508-996-4783
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANU 1386133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI29678-2OtherBCBS OF RI
AA27307OtherHPHC
655598OtherREGISTER DIETITIAN
LD0164OtherBCBS MA
1816971OtherCIGNA
468058OtherTUFTS HEALTH PLAN
MANU 1386OtherSTATE LICENSE
RI00412700OtherHMO BCBS OF RI
11463774OtherCAQH PROVIDER ID
LD0164OtherBCBS MA