Provider Demographics
NPI:1366464398
Name:O'MEARA, MARC (RD)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:
Last Name:O'MEARA
Suffix:
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 1:136 MILL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-1548
Mailing Address - Country:US
Mailing Address - Phone:978-486-3578
Mailing Address - Fax:978-486-3768
Practice Address - Street 1:25 BOYLSTON ST
Practice Address - Street 2:SUITE 312
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1715
Practice Address - Country:US
Practice Address - Phone:978-337-1059
Practice Address - Fax:978-486-3768
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1179133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALD0203OtherBCBS