Active NPI
Deborah M. Peterson, RD, CDE
- Registered Dietitian
- New London, CT
National Provider Identifier
1588891121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 000645
- Practice address
- 365 Montauk Ave
New London, CT 06320-4700 - Phone
- (860) 444-4737
- Fax
- (860) 444-4775
- NPI assigned
- Jun 22, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 000645 | CT | Primary |
Addresses
Primary practice location
365 Montauk Ave
New London, CT 06320-4700
Mailing address
365 Montauk Ave
New London, CT 06320-4700
Phone (860) 444-4737
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000645 | CT | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277769600000",
"number": "1588891121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "365 MONTAUK AVE",
"city": "NEW LONDON",
"state": "CT",
"postal_code": "063204700",
"telephone_number": "860-444-4737",
"fax_number": "860-444-4775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "365 MONTAUK AVE",
"city": "NEW LONDON",
"state": "CT",
"postal_code": "063204700",
"telephone_number": "860-444-4737",
"fax_number": "860-444-4775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "DEBORAH",
"middle_name": "M.",
"credential": "RD, CDE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-22",
"last_updated": "2010-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CT",
"license": "000645",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New London, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.