Provider Demographics
NPI:1982735403
Name:BRENDA J. BAILLARGEON, RD, LDN
Entity type:Organization
Organization Name:BRENDA J. BAILLARGEON, RD, LDN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAILLARGEON
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:508-883-7322
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01756-0506
Mailing Address - Country:US
Mailing Address - Phone:508-883-7322
Mailing Address - Fax:508-883-7322
Practice Address - Street 1:31 HASTINGS ST
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:MA
Practice Address - Zip Code:01756-1090
Practice Address - Country:US
Practice Address - Phone:508-883-7322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA378133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0000LD0021OtherBCBS PROVIDER NUMBER
MA0000LG0002OtherBCBS GROUP NUMBER
MA39476OtherHARVARD PILGRIM NUMBER
MAMT0225OtherMEDICARE, PTAN
MA000378OtherTUFTS PROVIDER NUMBER
MAMT0225OtherMEDICARE, PTAN