MEDICARE: SUSAN LANGEVIN MS, RD, CDE, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	042058	OTHER	MA	TUFTS HEALTH PLAN
2	LD0019	OTHER	MA	BC/BS OF MA
3	39437	OTHER	MA	HARVARD PILGRIM

General Provider Information

NPI Number	:	1770586539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN LANGEVIN MS, RD, CDE, LDN

Provider Business Mailing Address
First Line	:	9 BRANCH ST
Second Line	:
City	:	METHUEN
State	:	MA
Zip	:	01844-1947
Country	:	US
Telephone Number	:	978-683-9177
Fax Number	:	978-688-8679

Provider Business Practice Location Address
First Line	:	9 BRANCH ST
Second Line	:
City	:	METHUEN
State	:	MA
Zip	:	01844-1947
Country	:	US
Telephone Number	:	978-683-9177
Fax Number	:	978-688-8679

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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