Provider Demographics
NPI:1265586838
Name:DIANE R. DUBE LLC
Entity type:Organization
Organization Name:DIANE R. DUBE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUBE
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN, CDECES
Authorized Official - Phone:617-240-6383
Mailing Address - Street 1:PO BOX 8465
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01971-8465
Mailing Address - Country:US
Mailing Address - Phone:617-240-6383
Mailing Address - Fax:978-745-7982
Practice Address - Street 1:250 PARADISE ROAD
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907
Practice Address - Country:US
Practice Address - Phone:617-240-6383
Practice Address - Fax:978-745-7982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA748133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7388195OtherAETNA
MA39433OtherHARVARD PILGRIM HEALTH CA
MALG0031OtherBLUE CROSS BLUE SHIELD
MA798601OtherTVFTS HEALTH PLAN
MAL00036OtherBLUE CROSS BLUE SHIELD
MA1455252OtherCIGNA
MA39433OtherHARVARD PILGRIM HEALTH CA
MA39433OtherHARVARD PILGRIM HEALTH CA