Active NPI
Brendan Coburn, RD
- Registered Dietitian
- Manchester, CT
National Provider Identifier
1720480965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 03-912955
- Practice address
- 595 Main St
Manchester, CT 06040-5160 - Phone
- (860) 559-5178
- NPI assigned
- Sep 18, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 03-912955 | CT | Primary |
Addresses
Primary practice location
595 Main St
Manchester, CT 06040-5160
Mailing address
568 Foster St
South Windsor, CT 06074-2935
Phone (860) 559-5178
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03-912955 | CT | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cornerstone Nutrition, LLC | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410998400000",
"number": "1720480965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "568 FOSTER ST",
"city": "SOUTH WINDSOR",
"state": "CT",
"postal_code": "060742935",
"telephone_number": "860-559-5178"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "595 MAIN ST",
"city": "MANCHESTER",
"state": "CT",
"postal_code": "060405160",
"telephone_number": "860-559-5178"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COBURN",
"first_name": "BRENDAN",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-09-18",
"last_updated": "2014-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CT",
"license": "03-912955",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manchester, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.