Provider Demographics
NPI:1801101175
Name:HARPER, TED RYAN (MS, RD, CSSD, LDN)
Entity type:Individual
Prefix:
First Name:TED
Middle Name:RYAN
Last Name:HARPER
Suffix:
Gender:M
Credentials:MS, RD, CSSD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SOUTH AVE UNIT 902
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-4590
Mailing Address - Country:US
Mailing Address - Phone:317-626-7280
Mailing Address - Fax:
Practice Address - Street 1:1 PATRIOT PLACE
Practice Address - Street 2:GILLETTE STADIUM
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035-1388
Practice Address - Country:US
Practice Address - Phone:508-549-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-0786133V00000X
MALDN-3478133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered