Provider Demographics
NPI:1497841613
Name:BAUN, MARY ELIZABETH (RD, LDN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:BAUN
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 1:467 CRESCENT BOULEVARD EXT
Mailing Address - Street 2:
Mailing Address - City:CRESCENT
Mailing Address - State:PA
Mailing Address - Zip Code:15046-4909
Mailing Address - Country:US
Mailing Address - Phone:724-457-9414
Mailing Address - Fax:412-299-1295
Practice Address - Street 1:720 BLACKBURN RD
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1459
Practice Address - Country:US
Practice Address - Phone:412-299-1686
Practice Address - Fax:412-299-1295
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001515133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA091661UA2Medicare ID - Type Unspecified