Provider Demographics
NPI:1063976447
Name:LYNCH, MAGGIE (RDN, LDN)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 FANEUIL ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1863
Mailing Address - Country:US
Mailing Address - Phone:978-870-5017
Mailing Address - Fax:
Practice Address - Street 1:280 OLD CONNECTICUT PATH
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4539
Practice Address - Country:US
Practice Address - Phone:508-879-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4276133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered