Provider Demographics
NPI:1467678110
Name:CUMMINGS, SUSAN M (MS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 STANIFORD ST
Mailing Address - Street 2:4TH FLOOR, MGH WEIGHT CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2517
Mailing Address - Country:US
Mailing Address - Phone:617-724-6131
Mailing Address - Fax:617-724-6565
Practice Address - Street 1:50 STANIFORD ST
Practice Address - Street 2:4TH FLOOR, MGH WEIGHT CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2517
Practice Address - Country:US
Practice Address - Phone:617-724-6131
Practice Address - Fax:617-724-6565
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1632133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACUMT0265Medicare PIN