Provider Demographics
NPI:1265755987
Name:MACDONALD, MEGAN ELIZABETH (RD)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:ELIZABETH
Other - Last Name:BETRUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:30 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3602
Mailing Address - Country:US
Mailing Address - Phone:617-254-3800
Mailing Address - Fax:617-779-1460
Practice Address - Street 1:30 WARREN ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3602
Practice Address - Country:US
Practice Address - Phone:617-254-3800
Practice Address - Fax:617-779-1460
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2984133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered