Provider Demographics
NPI:1285896381
Name:MCGROARTY, THERESA M (MS RD LDN CDE)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:M
Last Name:MCGROARTY
Suffix:
Gender:F
Credentials:MS RD LDN CDE
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Mailing Address - Street 1:5201 HAVERFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-1401
Mailing Address - Country:US
Mailing Address - Phone:215-471-2763
Mailing Address - Fax:215-472-6092
Practice Address - Street 1:5201 HAVERFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-1401
Practice Address - Country:US
Practice Address - Phone:215-471-2763
Practice Address - Fax:215-472-6092
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2014-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PADN001097133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA144730E79Medicare PIN