Provider Demographics
NPI:1871622084
Name:MALONE, CATHERINE G (MS,RD,LDN)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:G
Last Name:MALONE
Suffix:
Gender:F
Credentials:MS,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 LAVENDER LN
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-3763
Mailing Address - Country:US
Mailing Address - Phone:508-668-8915
Mailing Address - Fax:508-668-8490
Practice Address - Street 1:700 S MAIN ST
Practice Address - Street 2:UNIT 2
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-2841
Practice Address - Country:US
Practice Address - Phone:781-784-0920
Practice Address - Fax:781-784-0925
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1717133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMA MT0671Medicare ID - Type Unspecified