Individual
MRS. MARY DIANE MCGOVERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
113 HOLLAND AVE, ALBANY, NY 12208-3410
(518) 626-6053
(518) 626-6075
Mailing address
3 PAUL AVENUE, LATHAM, NY 12210
(518) 782-0125
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
573908
—
Other
Enumeration date
10/14/2006
Last updated
07/08/2007
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