Provider Demographics
NPI:1518005883
Name:PILCZAK, GLORIA LOU (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:LOU
Last Name:PILCZAK
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01519-1179
Mailing Address - Country:US
Mailing Address - Phone:508-839-9969
Mailing Address - Fax:
Practice Address - Street 1:39 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01519-1179
Practice Address - Country:US
Practice Address - Phone:508-839-9969
Practice Address - Fax:508-839-9969
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15502133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMT 0668Medicare ID - Type Unspecified