Provider Demographics
NPI:1497969380
Name:DUMOULIN, DEBORAH K (RD, LD,)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:K
Last Name:DUMOULIN
Suffix:
Gender:F
Credentials:RD, LD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CLIFF LN
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9382
Mailing Address - Country:US
Mailing Address - Phone:207-283-8074
Mailing Address - Fax:
Practice Address - Street 1:MMC BARIATRIC SURGERY PROGRAM
Practice Address - Street 2:12 ANDOVER ROAD
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-761-5612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI217133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001554901Medicare PIN
ME001554903Medicare PIN
MEMT0407Medicare ID - Type UnspecifiedDIETITIAN