Provider Demographics
NPI:1700953502
Name:SIEBART, JUDITH MARIA (MS ,RD, LDN, CDE)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:MARIA
Last Name:SIEBART
Suffix:
Gender:F
Credentials:MS ,RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 HOPWOOD FAIRCHANCE RD
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-6509
Mailing Address - Country:US
Mailing Address - Phone:724-439-1971
Mailing Address - Fax:
Practice Address - Street 1:307 HOPWOOD FAIRCHANCE RD
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-6509
Practice Address - Country:US
Practice Address - Phone:724-439-1971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001344133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA099035Medicare ID - Type Unspecified
PA101528590001Medicare ID - Type Unspecified