Provider Demographics
NPI:1548880339
Name:CAMPANA, MEGAN CASEY (RD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:CASEY
Last Name:CAMPANA
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 1:161 LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MA
Mailing Address - Zip Code:01503-1015
Mailing Address - Country:US
Mailing Address - Phone:978-501-7561
Mailing Address - Fax:
Practice Address - Street 1:161 LANCASTER RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MA
Practice Address - Zip Code:01503-1015
Practice Address - Country:US
Practice Address - Phone:978-501-7561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4879-NU-NU133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered