Provider Demographics
NPI:1538161112
Name:DUBE, DIANE R (RDN, LDN, CDCES)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:R
Last Name:DUBE
Suffix:
Gender:F
Credentials:RDN, LDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 8465
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01971-8465
Mailing Address - Country:US
Mailing Address - Phone:617-240-6383
Mailing Address - Fax:978-745-7982
Practice Address - Street 1:250 PARADISE ROAD
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907
Practice Address - Country:US
Practice Address - Phone:617-240-6383
Practice Address - Fax:978-745-7982
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA748133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP46357Medicare UPIN
MAMT0061Medicare ID - Type Unspecified