Provider Demographics
NPI:1033802343
Name:NANCYMADDOXRD LLC
Entity Type:Organization
Organization Name:NANCYMADDOXRD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:978-500-8580
Mailing Address - Street 1:207 GROTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-1322
Mailing Address - Country:US
Mailing Address - Phone:978-500-8580
Mailing Address - Fax:
Practice Address - Street 1:234 LITTLETON RD
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3596
Practice Address - Country:US
Practice Address - Phone:978-500-8580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty