Healthcare Provider Details

I. General information

NPI: 1902845019
Provider Name (Legal Business Name): SUSAN O. HOHENADEL R.D.,C.D.E.,L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 N BETHLEHEM PIKE SUITE 300
LOWER GWYNEDD PA
19002-2655
US

IV. Provider business mailing address

877 MARTIN AVE
BRYN MAWR PA
19010-3821
US

V. Phone/Fax

Practice location:
  • Phone: 215-283-2833
  • Fax:
Mailing address:
  • Phone: 610-581-7592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN001058
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: