Provider Demographics
NPI:1952346611
Name:CAROBRESE, SUZANNE HARRIS (RD LD CNSD)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:HARRIS
Last Name:CAROBRESE
Suffix:
Gender:F
Credentials:RD LD CNSD
Other - Prefix:MS
Other - First Name:SUZANNE
Other - Middle Name:LYNN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD LD
Mailing Address - Street 1:3240 BLACKWALNUT DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-4651
Mailing Address - Country:US
Mailing Address - Phone:410-295-0754
Mailing Address - Fax:410-295-0754
Practice Address - Street 1:4940 EASTERN AVE
Practice Address - Street 2:JOHNS HOPKINS BAYVIEW MEDICAL CENTER CLINICAL NUTRITION
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2735
Practice Address - Country:US
Practice Address - Phone:410-550-1549
Practice Address - Fax:410-550-0650
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD02071133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered