Provider Demographics
NPI:1114358926
Name:MARTIN, SARAH (RDN)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4A FARNUM ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:MA
Mailing Address - Zip Code:01504-2222
Mailing Address - Country:US
Mailing Address - Phone:508-883-0044
Mailing Address - Fax:
Practice Address - Street 1:4A FARNUM ST
Practice Address - Street 2:
Practice Address - City:BLACKSTONE
Practice Address - State:MA
Practice Address - Zip Code:01504-2222
Practice Address - Country:US
Practice Address - Phone:508-883-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3333133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered