Provider Demographics
NPI:1437536232
Name:TCHEREPNIN, ANNE LONDON (MS, RD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:LONDON
Last Name:TCHEREPNIN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:LONDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RD
Mailing Address - Street 1:46 FERNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1163
Mailing Address - Country:US
Mailing Address - Phone:917-400-5071
Mailing Address - Fax:
Practice Address - Street 1:43 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1926
Practice Address - Country:US
Practice Address - Phone:917-400-5071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1084139133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered