Provider Demographics
NPI:1598095390
Name:LONDON, CLARISSA (RA, LD/N, LD)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:LONDON
Suffix:
Gender:F
Credentials:RA, LD/N, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MAHOGANY DRIVE
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1228
Mailing Address - Country:US
Mailing Address - Phone:603-889-8078
Mailing Address - Fax:
Practice Address - Street 1:101 ACCESS ROAD
Practice Address - Street 2:NORWOOD DIALYSIS CENTER
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-762-6944
Practice Address - Fax:781-762-6189
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA425133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered