MEDICARE: DEBORAH PEPPER-DOUGHERTY, RD, LD

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

General Provider Information

NPI Number	:	1902612690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBORAH PEPPER-DOUGHERTY, RD, LD

Provider Business Mailing Address
First Line	:	22 WILDWOOD BLVD
Second Line	:
City	:	CUMBERLAND FORESIDE
State	:	ME
Zip	:	04110-1213
Country	:	US
Telephone Number	:	207-318-7353
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 WILDWOOD BLVD
Second Line	:
City	:	CUMBERLAND FORESIDE
State	:	ME
Zip	:	04110-1213
Country	:	US
Telephone Number	:	207-318-7353
Fax Number	:	207-781-4925

Authorized Official
Title or Position	:	OWNER/DIEITIAN
Name	:	DEBORAH PEPPER-DOUGHERTY
Credential	:	RDN, LD
Telephone Number	:	207-781-4922

Provider Enumeration Date	:	12/06/2024
Last Update Date	:	04/21/2025

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