MEDICARE: SUSAN MOORE, MS RD LLC

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
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1285068759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN MOORE, MS RD LLC

Provider Business Mailing Address
First Line	:	901 PORTER ST APT 202
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-2208
Country	:	US
Telephone Number	:	703-209-3334
Fax Number	:	866-229-3445

Provider Business Practice Location Address
First Line	:	901 PORTER ST APT 202
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-2208
Country	:	US
Telephone Number	:	703-209-3334
Fax Number	:	866-229-3445

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

Provider Enumeration Date	:	09/02/2013
Last Update Date	:	04/05/2021

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