Provider Demographics
NPI:1093201931
Name:MARTIN, BRITTANY (RD, LDN)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 KIMBALL RD
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-5311
Mailing Address - Country:US
Mailing Address - Phone:789-478-8224
Mailing Address - Fax:
Practice Address - Street 1:65 KIMBALL RD
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-5311
Practice Address - Country:US
Practice Address - Phone:789-478-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4530133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001591800Medicaid