Healthcare Provider Details

I. General information

NPI: 1528089992
Provider Name (Legal Business Name): SUZANNE BURCHMAN M.ED., R.D., L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 LINCOLN ST VETERANS ADMINISTRATION OUTPATIENT CLINIC
WORCESTER MA
01605-1901
US

IV. Provider business mailing address

PO BOX 73
HOPKINTON MA
01748-0073
US

V. Phone/Fax

Practice location:
  • Phone: 508-856-0104
  • Fax: 508-856-7425
Mailing address:
  • Phone: 508-361-4588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number636
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: