Provider Demographics
NPI:1174227375
Name:ALTIZER, SAMANTHA A (RDN, LDN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:A
Last Name:ALTIZER
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5483 MOORETOWN RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2108
Mailing Address - Country:US
Mailing Address - Phone:757-941-6400
Mailing Address - Fax:
Practice Address - Street 1:5483 MOORETOWN RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2108
Practice Address - Country:US
Practice Address - Phone:757-941-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86102043133V00000X
FL9441133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered