Provider Demographics
NPI:1538217948
Name:MCDONALD, REBECCA CAROL (RD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:CAROL
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GLEASON RD
Mailing Address - Street 2:PROFESSIONAL BUILDING
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-5307
Mailing Address - Country:US
Mailing Address - Phone:518-384-0562
Mailing Address - Fax:
Practice Address - Street 1:9 GLEASON RD
Practice Address - Street 2:PROFESSIONAL BUILDING
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-5307
Practice Address - Country:US
Practice Address - Phone:518-384-0562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY962107133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6000910OtherMVP