Provider Demographics
NPI:1174923247
Name:MOORADIAN, ANNA (RD, LDN,)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:
Last Name:MOORADIAN
Suffix:
Gender:F
Credentials:RD, LDN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BREWSTER ST
Mailing Address - Street 2:APT #2
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43 HIGH ST
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-2097
Practice Address - Country:US
Practice Address - Phone:508-295-0880
Practice Address - Fax:508-273-4346
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000003605133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered