Provider Demographics
NPI:1356324040
Name:SMIGELSKI, CHARLIE JR (RD)
Entity Type:Individual
Prefix:MR
First Name:CHARLIE
Middle Name:
Last Name:SMIGELSKI
Suffix:JR
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MARRIGAN ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-3813
Mailing Address - Country:US
Mailing Address - Phone:781-643-4520
Mailing Address - Fax:781-643-4520
Practice Address - Street 1:16 MARRIGAN ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-3813
Practice Address - Country:US
Practice Address - Phone:781-643-4520
Practice Address - Fax:781-643-4520
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered