Provider Demographics
NPI:1598856650
Name:MEADE, MARYANN (MSRDCDECD-N)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:MEADE
Suffix:
Gender:F
Credentials:MSRDCDECD-N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 OAKDALE CIR
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-5700
Mailing Address - Country:US
Mailing Address - Phone:203-265-9756
Mailing Address - Fax:203-265-3411
Practice Address - Street 1:53 OAKDALE CIR
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-5700
Practice Address - Country:US
Practice Address - Phone:203-265-9756
Practice Address - Fax:203-265-3411
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000015133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT716534OtherCONNECTICARE
CTP2728328OtherOXFORD
CT270000015CT01OtherANTHEM BLUE CROSS