Healthcare Provider Details

I. General information

NPI: 1407657109
Provider Name (Legal Business Name): SAMANTHA FIDLER NTP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 THOREAU ST
CONCORD MA
01742-2411
US

IV. Provider business mailing address

1281 ELM ST
CONCORD MA
01742-2103
US

V. Phone/Fax

Practice location:
  • Phone: 978-218-8246
  • Fax:
Mailing address:
  • Phone: 978-697-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: