Provider Demographics
NPI:1700958840
Name:MCDONOUGH, ANDREA MARIE CHRISTOPHERSON (RD LDN)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MARIE CHRISTOPHERSON
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:CHRISTOPHERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:780 CHESTNUT STREET
Mailing Address - Street 2:SUITE 23
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1610
Mailing Address - Country:US
Mailing Address - Phone:413-787-2800
Mailing Address - Fax:413-787-2822
Practice Address - Street 1:780 CHESTNUT STREET
Practice Address - Street 2:SUITE 23
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1610
Practice Address - Country:US
Practice Address - Phone:413-787-2800
Practice Address - Fax:413-787-2822
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2230133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered