Provider Demographics
NPI:1215307392
Name:BIRCHWOOD NUTRITION GROUP INC.
Entity type:Organization
Organization Name:BIRCHWOOD NUTRITION GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/REGISTERED DIETITAN
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:MINOGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN
Authorized Official - Phone:781-724-9359
Mailing Address - Street 1:30 PURDUE DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1243
Mailing Address - Country:US
Mailing Address - Phone:781-724-9359
Mailing Address - Fax:
Practice Address - Street 1:77R W MAIN ST # R
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-1688
Practice Address - Country:US
Practice Address - Phone:781-724-9359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2088133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1366628463OtherINDIVIDUAL NPI
MA922444OtherCERTIFIED REGISTERED DIETITIAN
MA2088OtherMASS NUTRITION LICENSURE