Active NPI
Elizabeth Michelle Odvarka, MS, RDN, LDN
- Registered Dietitian
- Boston, MA
National Provider Identifier
1992275473
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 4604
- Practice address
- 185 Pilgrim Rd Dept of
Boston, MA 02215-5324 - Phone
- (857) 544-4508
- NPI assigned
- Nov 28, 2018
- Sex
- Female
- 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 | 4604 | MA | Primary |
Addresses
Primary practice location
185 Pilgrim Rd Dept of
Boston, MA 02215-5324
Mailing address
20 Lake St
Malden, MA 02148-1950
Phone (857) 544-4508
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4604 | MA | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1543363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543363200000",
"number": "1992275473",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 LAKE ST",
"city": "MALDEN",
"state": "MA",
"postal_code": "021481950",
"telephone_number": "857-544-4508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "185 PILGRIM RD DEPT OF",
"city": "BOSTON",
"state": "MA",
"postal_code": "022155324",
"telephone_number": "857-544-4508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODVARKA",
"first_name": "ELIZABETH",
"middle_name": "MICHELLE",
"name_prefix": "Miss",
"credential": "MS, RDN, LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-28",
"last_updated": "2018-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MA",
"license": "4604",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.