1952346611 NPI number — MRS. SUZANNE HARRIS CAROBRESE RD LD CNSD

Table of content: MRS. SUZANNE HARRIS CAROBRESE RD LD CNSD (NPI 1952346611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952346611 NPI number — MRS. SUZANNE HARRIS CAROBRESE RD LD CNSD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAROBRESE
Provider First Name:
SUZANNE
Provider Middle Name:
HARRIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD LD CNSD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARRIS
Provider Other First Name:
SUZANNE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD LD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1952346611
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3240 BLACKWALNUT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21403-4651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-295-0754
Provider Business Mailing Address Fax Number:
410-295-0754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4940 EASTERN AVE
Provider Second Line Business Practice Location Address:
JOHNS HOPKINS BAYVIEW MEDICAL CENTER CLINICAL NUTRITION
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21224-2735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-550-1549
Provider Business Practice Location Address Fax Number:
410-550-0650
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  D02071 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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