Provider Demographics
NPI:1174615470
Name:BOOTHBY, BARBARA (RD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BOOTHBY
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 1:75 MOUNT AUBURN ST
Mailing Address - Street 2:HARVARD UNIVERSITY HEALTH SERVICE
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4960
Mailing Address - Country:US
Mailing Address - Phone:617-496-8700
Mailing Address - Fax:617-495-6059
Practice Address - Street 1:75 MOUNT AUBURN ST
Practice Address - Street 2:HARVARD UNIVERSITY HEALTH SERVICE
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4960
Practice Address - Country:US
Practice Address - Phone:617-496-8700
Practice Address - Fax:617-495-6059
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2124133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMT0575Medicare ID - Type Unspecified