Provider Demographics
NPI:1659552966
Name:MORIARTY, BARBARA E (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:E
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HOSPITAL DRIVE
Mailing Address - Street 2:YORK HOSPITAL
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1011
Mailing Address - Country:US
Mailing Address - Phone:207-351-3702
Mailing Address - Fax:207-351-3701
Practice Address - Street 1:15 HOSPITAL DRIVE
Practice Address - Street 2:YORK HOSPITAL
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1011
Practice Address - Country:US
Practice Address - Phone:207-351-3702
Practice Address - Fax:207-351-3701
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI 441133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO MTO134Medicare PIN