Provider Demographics
NPI:1962706499
Name:CONRAD, CATHERINE (RD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:MAIMONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:8 GLEN HILL DR
Mailing Address - Street 2:
Mailing Address - City:SAUNDERSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02874-1918
Mailing Address - Country:US
Mailing Address - Phone:732-690-0717
Mailing Address - Fax:
Practice Address - Street 1:8 GLEN HILL DR
Practice Address - Street 2:
Practice Address - City:SAUNDERSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02874-1918
Practice Address - Country:US
Practice Address - Phone:732-690-0717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-23
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ999139133V00000X
RILDN00680133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI002529701Medicare PIN