Provider Demographics
NPI:1043830904
Name:RD 207, LLC
Entity Type:Organization
Organization Name:RD 207, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/ LLC MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:207-460-0550
Mailing Address - Street 1:301 WING RD
Mailing Address - Street 2:
Mailing Address - City:HERMON
Mailing Address - State:ME
Mailing Address - Zip Code:04401-0418
Mailing Address - Country:US
Mailing Address - Phone:207-460-0550
Mailing Address - Fax:
Practice Address - Street 1:6 STATE ST STE 607
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5140
Practice Address - Country:US
Practice Address - Phone:207-460-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty