Provider Demographics
NPI:1154643690
Name:BENJAMIN, SUZANNE C (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:C
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6602 CHURCH HILL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-2316
Mailing Address - Country:US
Mailing Address - Phone:410-778-0300
Mailing Address - Fax:410-778-0351
Practice Address - Street 1:6602 CHURCH HILL RD STE 200
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-2316
Practice Address - Country:US
Practice Address - Phone:410-778-0300
Practice Address - Fax:410-778-0351
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD375908133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered