Provider Demographics
NPI:1194866897
Name:STANTON, ELIZABETH MARGARET (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARGARET
Last Name:STANTON
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 OLD SALEM PATH
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-5275
Mailing Address - Country:US
Mailing Address - Phone:603-321-0478
Mailing Address - Fax:
Practice Address - Street 1:270 GREEN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3312
Practice Address - Country:US
Practice Address - Phone:857-259-1473
Practice Address - Fax:617-575-5860
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2259133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASTMT0748Medicare UPIN