MEDICARE: SUSAN M WILLIAMS LDN

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	MA90	MA

General Provider Information

NPI Number	:	1316921174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M WILLIAMS LDN

Provider Business Mailing Address
First Line	:	PO BOX 62
Second Line	:	TURNPIKE STATION
City	:	SHREWSBURY
State	:	MA
Zip	:	01545-0062
Country	:	US
Telephone Number	:	508-334-8815
Fax Number	:	508-334-5374

Provider Business Practice Location Address
First Line	:	67 BELMONT ST
Second Line	:	ENDOCRINOLOGY
City	:	WORCESTER
State	:	MA
Zip	:	01605-2657
Country	:	US
Telephone Number	:	508-775-4170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/08/2007

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