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NPI Code Detail

MEDICARE: SUSAN POLOMSKI MS,RD,CDE

MEDICARE: SUSAN POLOMSKI MS,RD,CDE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1114055415
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN POLOMSKI MS,RD,CDE
Provider Business Mailing Address
First Line : 1405 GROVE RD
Second Line : SUITE B
City : GREENVILLE
State : SC
Zip : 29605-4785
Country : US
Telephone Number : 865-295-3223
Fax Number : 865-295-3244
Provider Business Practice Location Address
First Line : 1405 GROVE RD
Second Line : SUITE B
City : GREENVILLE
State : SC
Zip : 29605-4785
Country : US
Telephone Number : 865-295-3223
Fax Number : 865-295-3244
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 07/08/2007

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