Healthcare Provider Details

I. General information

NPI: 1316079825
Provider Name (Legal Business Name): MARCIA JOHANNA SMITH MS RD LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 PROSPECT ST
NASHUA NH
03060-3925
US

IV. Provider business mailing address

8 REGINA RD
BROOKLINE NH
03033-2435
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-2000
  • Fax:
Mailing address:
  • Phone: 603-673-6701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number279
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: