Healthcare Provider Details

I. General information

NPI: 1467565275
Provider Name (Legal Business Name): MARYANN LUDLOW R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE ROOM 328
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

47 ORCHARD HL UNIT D
HINESBURG VT
05461-9408
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4512
  • Fax:
Mailing address:
  • Phone: 802-482-7789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0740000144
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: