Provider Demographics
NPI:1548584279
Name:BOITANO, MEGAN (RD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BOITANO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 EVELYN RD
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1612
Mailing Address - Country:US
Mailing Address - Phone:617-831-4420
Mailing Address - Fax:617-916-0893
Practice Address - Street 1:299 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1612
Practice Address - Country:US
Practice Address - Phone:617-831-4420
Practice Address - Fax:617-916-0893
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA888521133V00000X
MA4344133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered