Provider Demographics
NPI:1770651580
Name:DISCIULLO, LAN C (RD)
Entity Type:Individual
Prefix:MS
First Name:LAN
Middle Name:C
Last Name:DISCIULLO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 NEPONSET AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-3134
Mailing Address - Country:US
Mailing Address - Phone:617-282-3200
Mailing Address - Fax:617-282-7928
Practice Address - Street 1:398 NEPONSET AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-3134
Practice Address - Country:US
Practice Address - Phone:617-282-3200
Practice Address - Fax:617-282-7928
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2505133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered