Provider Demographics
NPI:1013469840
Name:KLIMAS, MARY ANN (RDN)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:KLIMAS
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 1:130 FISHER RD
Mailing Address - Street 2:CENTRAL VERMONT MEDICAL CENTER
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05641
Mailing Address - Country:US
Mailing Address - Phone:802-371-4150
Mailing Address - Fax:
Practice Address - Street 1:130 FISHER RD
Practice Address - Street 2:CENTRAL VERMONT MEDICAL CENTER
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-9004
Practice Address - Country:US
Practice Address - Phone:802-371-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074.0000003133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT074.0000003OtherSECRETARY OF STATE