Provider Demographics
NPI:1770530263
Name:PEPPER-DOUGHERTY, DEBORAH (RD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:PEPPER-DOUGHERTY
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:PEPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:22 WILDWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND FORESIDE
Mailing Address - State:ME
Mailing Address - Zip Code:04110-1213
Mailing Address - Country:US
Mailing Address - Phone:207-781-4410
Mailing Address - Fax:207-781-4925
Practice Address - Street 1:22 WILDWOOD BLVD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND FORESIDE
Practice Address - State:ME
Practice Address - Zip Code:04110-1213
Practice Address - Country:US
Practice Address - Phone:207-781-4922
Practice Address - Fax:207-781-4925
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI0340133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMT0339Medicare ID - Type Unspecified