MEDICARE: ELIZABETH COLGAN RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LDN01430	RI

General Provider Information

NPI Number	:	1245050335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH COLGAN RDN

Provider Business Mailing Address
First Line	:	1130 TEN ROD RD STE B203
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4165
Country	:	US
Telephone Number	:	401-426-5104
Fax Number	:	401-633-6956

Provider Business Practice Location Address
First Line	:	1130 TEN ROD RD STE B203
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4165
Country	:	US
Telephone Number	:	401-398-2454
Fax Number	:	401-633-6956

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2024
Last Update Date	:	04/06/2026

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