MEDICARE: MS. MARIAN D LALEVEE MS RD CDE LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	780	MA

General Provider Information

NPI Number	:	1033162664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIAN D LALEVEE MS RD CDE LDN

Provider Business Mailing Address
First Line	:	39 WONKAPIT WAY
Second Line	:
City	:	CHATHAM
State	:	MA
Zip	:	02633-1258
Country	:	US
Telephone Number	:	508-945-3897
Fax Number	:	508-945-1768

Provider Business Practice Location Address
First Line	:	537 ROUTE 28
Second Line	:	PORT CENTRE BLDG, SUITE 2G
City	:	HARWICH PORT
State	:	MA
Zip	:	02646
Country	:	US
Telephone Number	:	508-945-3897
Fax Number	:	508-945-1768

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	10/31/2007

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