Provider Demographics
NPI:1275168544
Name:DIETETIC ASSOCIATES, INC.
Entity Type:Organization
Organization Name:DIETETIC ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, CSG, LD
Authorized Official - Phone:440-487-8717
Mailing Address - Street 1:12376 CARROLL DR
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9444
Mailing Address - Country:US
Mailing Address - Phone:440-487-8717
Mailing Address - Fax:866-200-2885
Practice Address - Street 1:12376 CARROLL DR
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9444
Practice Address - Country:US
Practice Address - Phone:440-487-8717
Practice Address - Fax:866-200-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-07
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, GerontologicalGroup - Multi-Specialty