Provider Demographics
NPI:1598376840
Name:FREDERICK, ALORA L (RDN)
Entity Type:Individual
Prefix:
First Name:ALORA
Middle Name:L
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 POND ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-2841
Mailing Address - Country:US
Mailing Address - Phone:781-835-9089
Mailing Address - Fax:
Practice Address - Street 1:577 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-5527
Practice Address - Country:US
Practice Address - Phone:781-893-3870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered