Provider Demographics
NPI:1700060696
Name:BUCHANAN FISCHTROM, LINDA ANN (CD/N)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:BUCHANAN FISCHTROM
Suffix:
Gender:F
Credentials:CD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 OLD KINGS HWY S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4523
Mailing Address - Country:US
Mailing Address - Phone:203-655-4484
Mailing Address - Fax:
Practice Address - Street 1:36 OLD KINGS HWY S
Practice Address - Street 2:SUITE 200
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4523
Practice Address - Country:US
Practice Address - Phone:203-655-4484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03-529515133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist