Provider Demographics
NPI:1538179148
Name:BAHR, KRISTINE (MNT)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:BAHR
Suffix:
Gender:F
Credentials:MNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 WASHINGTON ST. SUITE 401
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445
Mailing Address - Country:US
Mailing Address - Phone:617-360-1929
Mailing Address - Fax:413-332-0719
Practice Address - Street 1:320 WASHINGTON ST. SUITE 401
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445
Practice Address - Country:US
Practice Address - Phone:413-528-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1707133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2804002OtherAETNA
MA39481OtherHARVARD PILGRIM
MA29366OtherHEALTH NEW ENGLAND
MA468764OtherTUFTS
MALD0088OtherBLUE SHIELD MASSACHUSETTS
MA29366OtherHEALTH NEW ENGLAND
MAMT0066Medicare ID - Type Unspecified