Provider Demographics
NPI:1194735340
Name:GALLAGHER, MAUREEN CLARE (MHA, RD, CDE)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:CLARE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MHA, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 KING JAMES RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03748-3818
Mailing Address - Country:US
Mailing Address - Phone:802-295-9363
Mailing Address - Fax:802-296-6328
Practice Address - Street 1:215 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05009-0001
Practice Address - Country:US
Practice Address - Phone:802-295-9363
Practice Address - Fax:802-296-6328
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered