Provider Demographics
NPI:1326759358
Name:GREENWOOD, TARA MARIE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MARIE
Last Name:GREENWOOD
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 1:515 E BROADWAY APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-4496
Mailing Address - Country:US
Mailing Address - Phone:484-639-4399
Mailing Address - Fax:
Practice Address - Street 1:10 TOWER OFFICE PARK STE 212
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2120
Practice Address - Country:US
Practice Address - Phone:617-871-9640
Practice Address - Fax:855-453-0835
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN6611133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered