Provider Demographics
NPI:1326196064
Name:GARGIULO, MARITA (PHD, RD, CDN)
Entity type:Individual
Prefix:DR
First Name:MARITA
Middle Name:
Last Name:GARGIULO
Suffix:
Gender:F
Credentials:PHD, RD, CDN
Other - Prefix:
Other - First Name:MARITA
Other - Middle Name:GARGIULO
Other - Last Name:HOLL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:255 HILL ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1521
Mailing Address - Country:US
Mailing Address - Phone:203-248-8047
Mailing Address - Fax:
Practice Address - Street 1:100 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2365
Practice Address - Country:US
Practice Address - Phone:203-248-8047
Practice Address - Fax:203-248-8047
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000020133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP817491OtherOXFORD
CT270000020CT01OtherANTHEM BCBS
CT714375OtherCONNECTICARE