Provider Demographics
NPI:1528088317
Name:NORMAND, POLLY (MPH, RD, LDN, CDE)
Entity type:Individual
Prefix:
First Name:POLLY
Middle Name:
Last Name:NORMAND
Suffix:
Gender:F
Credentials:MPH, RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3807
Mailing Address - Country:US
Mailing Address - Phone:413-786-2957
Mailing Address - Fax:413-786-2977
Practice Address - Street 1:3 FRUIT ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3807
Practice Address - Country:US
Practice Address - Phone:413-786-2957
Practice Address - Fax:413-786-2977
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2232133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4609501OtherCIGNA
MA11326384OtherCAQH
MALD0152OtherBLUE CROSS BLUE SHIELD
MA469911OtherTUFTS
MA35122OtherHEALTH NEW ENGLAND
MAAA59459OtherHARVARD PILGRIM
MALD0152OtherBLUE CROSS BLUE SHIELD