Provider Demographics
NPI:1801443825
Name:BAUER, KATHARINE (RD)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ABERDEEN WAY STE 124
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4659
Mailing Address - Country:US
Mailing Address - Phone:860-304-4617
Mailing Address - Fax:
Practice Address - Street 1:1 ABERDEEN WAY STE 124
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4659
Practice Address - Country:US
Practice Address - Phone:860-304-4617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86101973133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered