Individual
MARY ANN GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSRD LDN
Contact information
Practice address
630 PLANTATION STREET, WORCESTER, MA 01605
(508) 852-6175
(508) 595-2941
Mailing address
630 PLANTATION STREET, WORCESTER, MA 01605
(508) 852-6175
(508) 595-2941
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
216
MA
133V00000X
Registered Dietitian
Primary
216
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042472266
PRIVATE HEALTHCARE SYSTEM
—
01
—
67850
FALLON COMMUNITY HEALTH P
—
01
—
7856570
AETNA US HEALTHCARE
—
01
—
AA16843
HARVARD PILGRIM HEALTHCAR
—
01
—
LD0142
BLUE CROSS
—
01
—
MT0708
MEDICARE B
—
Enumeration date
08/25/2006
Last updated
02/04/2009
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