Provider Demographics
NPI:1124171665
Name:METABOLIC DESIGNS, INC.
Entity type:Organization
Organization Name:METABOLIC DESIGNS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED REGISTERED DIETITIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CANNAVA
Authorized Official - Suffix:JR
Authorized Official - Credentials:LDRD
Authorized Official - Phone:781-938-6392
Mailing Address - Street 1:186 CAMBRIDGE RD
Mailing Address - Street 2:SUITE #11
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-4793
Mailing Address - Country:US
Mailing Address - Phone:781-938-6392
Mailing Address - Fax:781-938-7412
Practice Address - Street 1:186 CAMBRIDGE RD
Practice Address - Street 2:SUITE #11
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-4793
Practice Address - Country:US
Practice Address - Phone:781-938-6392
Practice Address - Fax:781-938-7412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA133V00000X133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA39478OtherHARVARD PILGRAM
MALD0064OtherBLUE CROSS BLUE SHIELD
MAMEMT0536Medicare ID - Type Unspecified