Provider Demographics
NPI:1285068759
Name:SUSAN MOORE, MS RD LLC
Entity type:Organization
Organization Name:SUSAN MOORE, MS RD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:SHARON
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:703-644-4461
Mailing Address - Street 1:901 PORTER ST APT 202
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-2208
Mailing Address - Country:US
Mailing Address - Phone:703-209-3334
Mailing Address - Fax:866-229-3445
Practice Address - Street 1:901 PORTER ST APT 202
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-2208
Practice Address - Country:US
Practice Address - Phone:703-209-3334
Practice Address - Fax:866-229-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-02
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty