Provider Demographics
NPI:1801914015
Name:RASTOGI, BHARATI KOLI (RD)
Entity type:Individual
Prefix:MRS
First Name:BHARATI
Middle Name:KOLI
Last Name:RASTOGI
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 1:45 GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3902
Mailing Address - Country:US
Mailing Address - Phone:978-746-7846
Mailing Address - Fax:
Practice Address - Street 1:17 WARREN ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2216
Practice Address - Country:US
Practice Address - Phone:978-446-0788
Practice Address - Fax:978-453-1777
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1083133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered