Healthcare Provider Details

I. General information

NPI: 1285068759
Provider Name (Legal Business Name): SUSAN MOORE, MS RD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2013
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PORTER ST APT 202
RICHMOND VA
23224-2208
US

IV. Provider business mailing address

901 PORTER ST APT 202
RICHMOND VA
23224-2208
US

V. Phone/Fax

Practice location:
  • Phone: 703-209-3334
  • Fax: 866-229-3445
Mailing address:
  • Phone: 703-209-3334
  • Fax: 866-229-3445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: SUSAN SHARON MOORE
Title or Position: REGISTERED DIETITIAN/OWNER
Credential: MS, RD
Phone: 703-644-4461