1154854545 NPI number — MS. SUSANNAH LIN EDWARDS MS RDN LD

Table of content: MS. SUSANNAH LIN EDWARDS MS RDN LD (NPI 1154854545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154854545 NPI number — MS. SUSANNAH LIN EDWARDS MS RDN LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS
Provider First Name:
SUSANNAH
Provider Middle Name:
LIN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS RDN LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154854545
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1707 BLACK OAK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20910-1423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-449-3094
Provider Business Mailing Address Fax Number:
240-489-4415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10215 FERNWOOD RD
Provider Second Line Business Practice Location Address:
SUITE 630
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20817-1106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-449-3094
Provider Business Practice Location Address Fax Number:
240-489-4415
Provider Enumeration Date:
04/04/2017

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:  DX4187 , 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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