Provider Demographics
NPI:1578674172
Name:GAZZILLO, PETER WILLIAM (RD, LDN)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:WILLIAM
Last Name:GAZZILLO
Suffix:
Gender:M
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 1:25 PLEASANTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:MA
Mailing Address - Zip Code:01226-2047
Mailing Address - Country:US
Mailing Address - Phone:413-822-0261
Mailing Address - Fax:
Practice Address - Street 1:165 TOR CT
Practice Address - Street 2:BERKSHIRE MEDICAL CENTER HILLCREST CAMPUS
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-3001
Practice Address - Country:US
Practice Address - Phone:413-445-9539
Practice Address - Fax:413-445-9326
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5133N00000X
MA727180133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric