Provider Demographics
NPI:1134208127
Name:COLLINS, JOHN PETER (RD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PETER
Last Name:COLLINS
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LARSON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-1072
Mailing Address - Country:US
Mailing Address - Phone:978-276-5646
Mailing Address - Fax:978-276-5646
Practice Address - Street 1:1 LARSON RD
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-1072
Practice Address - Country:US
Practice Address - Phone:978-276-5646
Practice Address - Fax:978-276-5646
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA565133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered