Provider Demographics
NPI:1902612690
Name:DEBORAH PEPPER-DOUGHERTY, RD, LD
Entity type:Organization
Organization Name:DEBORAH PEPPER-DOUGHERTY, RD, LD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIEITIAN
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPPER-DOUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:207-781-4922
Mailing Address - Street 1:22 WILDWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND FORESIDE
Mailing Address - State:ME
Mailing Address - Zip Code:04110-1213
Mailing Address - Country:US
Mailing Address - Phone:207-318-7353
Mailing Address - Fax:
Practice Address - Street 1:22 WILDWOOD BLVD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND FORESIDE
Practice Address - State:ME
Practice Address - Zip Code:04110-1213
Practice Address - Country:US
Practice Address - Phone:207-318-7353
Practice Address - Fax:207-781-4925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-06
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty