Provider Demographics
NPI:1619435542
Name:MCGOWAN, SARA DIETRICH (RD, LDN, CNSC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:DIETRICH
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:RD, LDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 WASHINGTON ST # 2
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2141
Mailing Address - Country:US
Mailing Address - Phone:518-221-2401
Mailing Address - Fax:
Practice Address - Street 1:189 WASHINGTON ST # 2
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2141
Practice Address - Country:US
Practice Address - Phone:518-221-2401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty