Provider Demographics
NPI:1841724671
Name:GEROUX, MEAGHAN (MS, RDN, LD)
Entity type:Individual
Prefix:MRS
First Name:MEAGHAN
Middle Name:
Last Name:GEROUX
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04967-3707
Mailing Address - Country:US
Mailing Address - Phone:207-487-4000
Mailing Address - Fax:
Practice Address - Street 1:167 LEIGHTON ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:ME
Practice Address - Zip Code:04967-3718
Practice Address - Country:US
Practice Address - Phone:207-487-4068
Practice Address - Fax:207-487-6812
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1276133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered