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Provider Information for 1669725123

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

MS. LESLIE RATHFON MATTIMORE MS, RD, LDN

Gender: FEMALE

Individual NPI: 1669725123

Calendar   Last Updated:  2014-03-05
  Certification Date: 

Details

Name Value
NPI 1669725123
Enumeration Date 2012-10-22
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 300 LONGWOOD AVE BOSTON CHILDREN'S HOSPITAL
BOSTON, MA 02115-5724
United States

Phone: 607-341-3864 | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE
BOSTON, MA 02115-5724
United States

Phone: 607-341-3864 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 133V00000X - Dietitian, Registered MA 3366