Provider Demographics
NPI:1528228731
Name:STRATTON, MARY E (RD,LDN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:STRATTON
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 1:271 CAREW ST
Mailing Address - Street 2:P.O. BOX 9012
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2377
Mailing Address - Country:US
Mailing Address - Phone:413-748-9183
Mailing Address - Fax:413-736-1779
Practice Address - Street 1:271 CAREW ST
Practice Address - Street 2:NUTRITION DEPARTMENT
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2377
Practice Address - Country:US
Practice Address - Phone:413-748-9183
Practice Address - Fax:413-736-1779
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2207133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
00918051OtherADA MEMBER #
MA2207OtherMA LICENSE #