Provider Demographics
NPI:1609595123
Name:MARTIN, SANDRA M (RD LDN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDLDN
Mailing Address - Street 1:6 INGATE TER
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-3849
Mailing Address - Country:US
Mailing Address - Phone:443-690-8829
Mailing Address - Fax:
Practice Address - Street 1:6 INGATE TER
Practice Address - Street 2:
Practice Address - City:HALETHORPE
Practice Address - State:MD
Practice Address - Zip Code:21227-3849
Practice Address - Country:US
Practice Address - Phone:443-690-8829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01737133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered