Healthcare Provider Details

I. General information

NPI: 1588801799
Provider Name (Legal Business Name): BRENDA BAILLARGEON R.D., L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 HASTINGS ST
MENDON MA
01756-1090
US

IV. Provider business mailing address

PO BOX 506 31 HASTINGS ST.
MENDON MA
01756-0506
US

V. Phone/Fax

Practice location:
  • Phone: 508-883-7322
  • Fax:
Mailing address:
  • Phone: 508-883-7322
  • Fax: 508-883-7322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number378
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: