Provider Demographics
NPI:1316573967
Name:BATEMAN, SAMANTHA (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 CAMBRIDGE ST STE 402
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2750
Mailing Address - Country:US
Mailing Address - Phone:617-726-2779
Mailing Address - Fax:
Practice Address - Street 1:165 CAMBRIDGE ST STE 402
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2750
Practice Address - Country:US
Practice Address - Phone:617-726-2779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5008-NU-NU133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered