Provider Demographics
NPI:1407949043
Name:JOHNSON, ELVIRA QUIROGA (MS,RD,CDE,LDN)
Entity Type:Individual
Prefix:MS
First Name:ELVIRA
Middle Name:QUIROGA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS,RD,CDE,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FLINT STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864
Mailing Address - Country:US
Mailing Address - Phone:978-664-3093
Mailing Address - Fax:
Practice Address - Street 1:15 COMMONWEALTH AVE
Practice Address - Street 2:NEIGHBORHOOD DIABETES
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-5193
Practice Address - Country:US
Practice Address - Phone:866-784-5647
Practice Address - Fax:781-246-1978
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANU850133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA469779OtherTUFTS HEALTH CARE
MALD0129OtherBCBSMA
MALD0129OtherBCBSMA