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NPI Code Detail

MEDICARE: SAMANTHA BERNHARDT RDN

MEDICARE: SAMANTHA BERNHARDT RDN
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 DietitianAPP-000715981OH

General Provider Information

NPI Number : 1669160982
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA BERNHARDT RDN
Provider Business Mailing Address
First Line : 4359 E ENON RD
Second Line :
City : YELLOW SPRINGS
State : OH
Zip : 45387-9708
Country : US
Telephone Number : 937-206-1131
Fax Number : 937-917-8048
Provider Business Practice Location Address
First Line : 2025 RIVERSIDE DR STE 204
Second Line :
City : UPPER ARLINGTON
State : OH
Zip : 43221-4012
Country : US
Telephone Number : 937-206-1131
Fax Number : 937-917-8048
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2023
Last Update Date : 05/02/2023

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