Provider Demographics
NPI:1336393115
Name:NEWMAN, MOLLY B (RD, LDN)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:B
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WHITNEY RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:MA
Mailing Address - Zip Code:01775-1234
Mailing Address - Country:US
Mailing Address - Phone:617-504-6738
Mailing Address - Fax:
Practice Address - Street 1:27 WHITNEY RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:MA
Practice Address - Zip Code:01775-1234
Practice Address - Country:US
Practice Address - Phone:617-504-6738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2808133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered