Provider Demographics
NPI:1881966216
Name:BERGLUND, CAROL ANN (RD)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:BERGLUND
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01524-2131
Mailing Address - Country:US
Mailing Address - Phone:508-892-1300
Mailing Address - Fax:508-892-0200
Practice Address - Street 1:10 MEADOW LN
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:MA
Practice Address - Zip Code:01524-2131
Practice Address - Country:US
Practice Address - Phone:508-892-1300
Practice Address - Fax:508-892-0200
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3040133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered