Provider Demographics
NPI:1497118780
Name:MADZIAR, CAMILLA E (RD, LDN)
Entity Type:Individual
Prefix:
First Name:CAMILLA
Middle Name:E
Last Name:MADZIAR
Suffix:
Gender:F
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 1:630 PLANTATION ST
Mailing Address - Street 2:WOT 12TH FL
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-368-5532
Mailing Address - Fax:
Practice Address - Street 1:630 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2038
Practice Address - Country:US
Practice Address - Phone:508-852-6175
Practice Address - Fax:508-595-2122
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2021-02-09
Deactivation Date:2018-12-21
Deactivation Code:
Reactivation Date:2021-02-09
Provider Licenses
StateLicense IDTaxonomies
MA3857133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered