Provider Demographics
NPI:1275911273
Name:SMITH, SUZANNE HUMMEL (RDN)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:HUMMEL
Last Name:SMITH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 CORSLEY CT
Mailing Address - Street 2:
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3137
Mailing Address - Country:US
Mailing Address - Phone:215-669-4995
Mailing Address - Fax:
Practice Address - Street 1:589 SKIPPACK PIKE STE 400
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2159
Practice Address - Country:US
Practice Address - Phone:215-628-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000297133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103622820Medicaid