Individual
MRS. SUSAN GAIL BAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED DIETITIAN
Contact information
Practice address
13135 LEE JACKSON MEMORIAL HWY, STE 201, FAIRFAX, VA 22033-1907
(703) 999-6290
(703) 241-7723
Mailing address
15505 VINE COTTAGE DR, CENTREVILLE, VA 20120-3750
(703) 999-6290
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4624075
AETNA PROVIDER ID
VA
Enumeration date
02/03/2007
Last updated
08/09/2018
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