MEDICARE: MARIAN D LALEVEE, MS RD CDE LDN LLC

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	:	1558571901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIAN D LALEVEE, MS RD CDE LDN LLC

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 2 G
City	:	HARWICH PORT
State	:	MA
Zip	:	02646-1894
Country	:	US
Telephone Number	:	508-945-3897
Fax Number	:	508-945-1768

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIAN D LALEVEE
Credential	:	MS RD CDE LDN LLC
Telephone Number	:	508-945-3897

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	01/07/2008

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