Healthcare Provider Details

I. General information

NPI: 1194735340
Provider Name (Legal Business Name): MAUREEN CLARE GALLAGHER MHA, RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N MAIN ST
WHITE RIVER JUNCTION VT
05009-0001
US

IV. Provider business mailing address

111 KING JAMES RD
ENFIELD NH
03748-3818
US

V. Phone/Fax

Practice location:
  • Phone: 802-295-9363
  • Fax: 802-296-6328
Mailing address:
  • Phone: 802-295-9363
  • Fax: 802-296-6328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: