Provider Demographics
NPI:1083888226
Name:COLGAN, MARILOU (RD)
Entity Type:Individual
Prefix:
First Name:MARILOU
Middle Name:
Last Name:COLGAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MARILOU
Other - Middle Name:
Other - Last Name:HALM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 KINGSLEY LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4602
Mailing Address - Country:US
Mailing Address - Phone:757-889-4139
Mailing Address - Fax:757-889-5399
Practice Address - Street 1:150 KINGSLEY LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4602
Practice Address - Country:US
Practice Address - Phone:757-889-4139
Practice Address - Fax:757-889-5399
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA589599133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered