Active NPI
Susan N Bol, R.D.
- Registered Dietitian
- Worcester, MA
National Provider Identifier
1396895603
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1304
- Practice address
- 55 Lake Ave North
Ummhc
Worcester, MA 01655 - Phone
- (508) 856-3367
- Fax
- (508) 856-8020
- NPI assigned
- Jan 11, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1304 | MA | Primary |
Addresses
Primary practice location
55 Lake Ave North
Ummhc
Worcester, MA 01655
Mailing address
269 Williams St
Uxbridge, MA 01569-1130
Phone (508) 856-3367
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1304 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1396895603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "269 WILLIAMS ST",
"city": "UXBRIDGE",
"state": "MA",
"postal_code": "015691130",
"telephone_number": "508-856-3367",
"fax_number": "508-856-8020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 LAKE AVE NORTH",
"address_2": "UMMHC",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01655",
"telephone_number": "508-856-3367",
"fax_number": "508-856-8020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOL",
"first_name": "SUSAN",
"middle_name": "N",
"name_prefix": "Mrs.",
"credential": "R.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MA",
"license": "1304",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.