MEDICARE: MS. SUSAN MARKUS RD

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	000493	CT

General Provider Information

NPI Number	:	1437263456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN MARKUS RD

Provider Business Mailing Address
First Line	:	840 NEW BRITAIN AVE
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-2129
Country	:	US
Telephone Number	:	860-585-3166
Fax Number	:	860-585-3081

Provider Business Practice Location Address
First Line	:	840 NEW BRITAIN AVE
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-2129
Country	:	US
Telephone Number	:	860-585-3166
Fax Number	:	860-585-3081

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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