Provider Demographics
NPI:1821219494
Name:STANTON, PETER (LDN)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:STANTON
Suffix:
Gender:M
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE NUTRITION CENTER
Mailing Address - Street 2:94 MAIN STREET
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230
Mailing Address - Country:US
Mailing Address - Phone:413-528-9311
Mailing Address - Fax:
Practice Address - Street 1:THE NUTRITION CENTER
Practice Address - Street 2:94 MAIN STREET
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230
Practice Address - Country:US
Practice Address - Phone:413-528-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN531133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALD0195OtherBLUE CROSS BLUE SHIELD
MAMT0658Medicare ID - Type UnspecifiedMEDICARE PART B