Provider Demographics
NPI:1326303561
Name:ELLIOTT, JULIA WADE (RD LDN)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:WADE
Last Name:ELLIOTT
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 1:54 WESTFORD RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-5209
Mailing Address - Country:US
Mailing Address - Phone:617-510-0479
Mailing Address - Fax:
Practice Address - Street 1:54 WESTFORD RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-5209
Practice Address - Country:US
Practice Address - Phone:617-510-0479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2132133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered