Provider Demographics
NPI:1407657109
Name:FIDLER, SAMANTHA (NTP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:FIDLER
Suffix:
Gender:
Credentials:NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1281 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2103
Mailing Address - Country:US
Mailing Address - Phone:978-697-1414
Mailing Address - Fax:
Practice Address - Street 1:42 THOREAU ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2411
Practice Address - Country:US
Practice Address - Phone:978-218-8246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist