Provider Demographics
NPI:1588692347
Name:DONNELLY, MARILYN BALA (RD)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:BALA
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CENTER FOR INTEGRATIVE MEDICINE
Mailing Address - Street 2:171 PLEASANT ST
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-228-7600
Mailing Address - Fax:603-228-7320
Practice Address - Street 1:CENTER FOR INTEGRATIVE MEDICINE
Practice Address - Street 2:171 PLEASANT ST
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-228-7600
Practice Address - Fax:603-228-7320
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH172133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered