Provider Demographics
NPI:1588801799
Name:BAILLARGEON, BRENDA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BAILLARGEON
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:PO BOX 506
Mailing Address - Street 2:31 HASTINGS ST.
Mailing Address - City:MENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01756-0506
Mailing Address - Country:US
Mailing Address - Phone:508-883-7322
Mailing Address - Fax:508-883-7322
Practice Address - Street 1:31 HASTINGS ST
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:MA
Practice Address - Zip Code:01756-1090
Practice Address - Country:US
Practice Address - Phone:508-883-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA378133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMT0225OtherMEDICARE, PTAN
MAP55396Medicare UPIN