Provider Demographics
NPI:1013210277
Name:PHILPOTTS, MARLAINE (RD)
Entity Type:Individual
Prefix:
First Name:MARLAINE
Middle Name:
Last Name:PHILPOTTS
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 1:27 HARTFORD TPKE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-5245
Mailing Address - Country:US
Mailing Address - Phone:860-559-7262
Mailing Address - Fax:860-649-1354
Practice Address - Street 1:27 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-5245
Practice Address - Country:US
Practice Address - Phone:860-647-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000710133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered