Provider Demographics
NPI:1104678432
Name:AMBARTSUMIAN, REBEKAH (RDN)
Entity type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:
Last Name:AMBARTSUMIAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 TOWNSHIP LINE RD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2220
Mailing Address - Country:US
Mailing Address - Phone:215-663-6422
Mailing Address - Fax:
Practice Address - Street 1:60 TOWNSHIP LINE RD FL 2
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2220
Practice Address - Country:US
Practice Address - Phone:215-663-6422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN008427133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered