Samuel Houghton Mudge, MS, RD, LDN
Dietitian, Registered in Cambridge, MA. Individual provider (NPI-1).
NPI number1417615212
StatusActive
Last updated in NPPESNov 30, 2021
Details
- NPI
- 1417615212
- Entity type
- Individual (NPI-1)
- Name
- Mr. Samuel Houghton Mudge
- Credential
- MS, RD, LDN
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Nov 30, 2021
- Certification date
- Nov 30, 2021
- Last updated
- Nov 30, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 133V00000X | Dietitian, Registered | 5233 | MA | Yes |
Practice location
1493 Cambridge StCambridge, MA 02139-1099
Phone 617-665-1000
Mailing address
29 Brainerd Rd Apt 105Boston, MA 02134-4526
Phone 603-703-1934
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