Provider Demographics
NPI:1477959310
Name:COWMEADOW, SUSAN HILTON (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:HILTON
Last Name:COWMEADOW
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:HILTON
Other - Last Name:COWMEADOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:15 RYE ST
Mailing Address - Street 2:STE 305
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-6846
Mailing Address - Country:US
Mailing Address - Phone:603-957-1885
Mailing Address - Fax:
Practice Address - Street 1:483 EXETER RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-1000
Practice Address - Country:US
Practice Address - Phone:603-957-1885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH29133V00000X
MA3751133V00000X
RILDN00885133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered