Provider Demographics
NPI:1326776816
Name:BAUMGARTEN, SUSAN M (RD, LDN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:BAUMGARTEN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 HERRING RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WELLFLEET
Mailing Address - State:MA
Mailing Address - Zip Code:02667-7031
Mailing Address - Country:US
Mailing Address - Phone:617-699-8529
Mailing Address - Fax:
Practice Address - Street 1:180 HERRING RIVER RD
Practice Address - Street 2:
Practice Address - City:WELLFLEET
Practice Address - State:MA
Practice Address - Zip Code:02667-7031
Practice Address - Country:US
Practice Address - Phone:617-699-8529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
IL381429133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered