Provider Demographics
NPI:1376074898
Name:FREGOSI, GINA MARIE (RDN, CDN, LDN)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:FREGOSI
Suffix:
Gender:F
Credentials:RDN, CDN, LDN
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 HIGH ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-2125
Mailing Address - Country:US
Mailing Address - Phone:860-652-5719
Mailing Address - Fax:
Practice Address - Street 1:11 HIGH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-2125
Practice Address - Country:US
Practice Address - Phone:860-652-5719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-26
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2613133V00000X
CT000781133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered