Healthcare Provider Details

I. General information

NPI: 1770530263
Provider Name (Legal Business Name): DEBORAH PEPPER-DOUGHERTY R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH ANN PEPPER R.D.

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 WILDWOOD BLVD
CUMBERLAND FORESIDE ME
04110-1213
US

IV. Provider business mailing address

22 WILDWOOD BLVD
CUMBERLAND FORESIDE ME
04110-1213
US

V. Phone/Fax

Practice location:
  • Phone: 207-781-4922
  • Fax: 207-781-4925
Mailing address:
  • Phone: 207-781-4410
  • Fax: 207-781-4925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI0340
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: