Provider Demographics
NPI:1336465202
Name:PARE, MARCELLA J (RD, LDN)
Entity Type:Individual
Prefix:
First Name:MARCELLA
Middle Name:J
Last Name:PARE
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 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-221-6258
Mailing Address - Fax:717-221-6266
Practice Address - Street 1:101 WASHINGTON STREET
Practice Address - Street 2:LEARNING INSTITUTE
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-1675
Practice Address - Country:US
Practice Address - Phone:717-221-6258
Practice Address - Fax:717-221-6266
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000194133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102463935Medicaid