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General NPI Number Information
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NPI Number | 1407657109
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Entity Type | Individual
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Provider Name | SAMANTHA FIDLER NTP
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Gender | Female
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Dates
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Enumeration Date | 03/20/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 42 THOREAU ST
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City | CONCORD
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State | MA
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Zip | 01742-2411
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Country | US
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Telephone | 978-218-8246
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Fax |
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Provider Business Mailing Address
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Address Line | 1281 ELM ST
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City | CONCORD
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State | MA
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Zip | 01742-2103
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Country | US
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Telephone | 978-697-1414
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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