Provider Demographics
NPI:1124575964
Name:MARSHALL, SUSAN R (RD MS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 COX RD STE 150
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6507
Mailing Address - Country:US
Mailing Address - Phone:804-346-1780
Mailing Address - Fax:804-346-1781
Practice Address - Street 1:4900 COX RD STE 150
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6507
Practice Address - Country:US
Practice Address - Phone:804-346-1780
Practice Address - Fax:804-346-1781
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered