Provider Demographics
NPI:1508043878
Name:TRAIL, DOROTHY MAY
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:MAY
Last Name:TRAIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6498 MOSSY BANK PARK RD
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-8165
Mailing Address - Country:US
Mailing Address - Phone:607-776-7869
Mailing Address - Fax:
Practice Address - Street 1:6498 MOSSY BANK PARK RD
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-8165
Practice Address - Country:US
Practice Address - Phone:607-776-7869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0044341133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD3771OtherMEDICARE PROVIDER NUMBER