Provider Demographics
NPI:1417964586
Name:JASON, KATHERINE T (RD LDN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:T
Last Name:JASON
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:T
Other - Last Name:BIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LDN
Mailing Address - Street 1:77 HERRICK ST
Mailing Address - Street 2:STE 101
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3012
Mailing Address - Country:US
Mailing Address - Phone:978-927-4110
Mailing Address - Fax:978-232-7057
Practice Address - Street 1:77 HERRICK ST
Practice Address - Street 2:STE 101
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-3012
Practice Address - Country:US
Practice Address - Phone:978-927-4110
Practice Address - Fax:978-232-7057
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA889623133V00000X
MA2313133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALD0177OtherBS
MALD0177OtherBS