Healthcare Provider Details

I. General information

NPI: 1679406581
Provider Name (Legal Business Name): ELIZABETH VARGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MAIN ST STE 248
SACO ME
04072-3527
US

IV. Provider business mailing address

26 BERWICK RD
SANFORD ME
04073-4032
US

V. Phone/Fax

Practice location:
  • Phone: 207-413-1306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI1722
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: