Provider Demographics
NPI:1720538309
Name:FALCONER, EMMA MARY (RD, LDN)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:MARY
Last Name:FALCONER
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 1:3 BOW ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5109
Mailing Address - Country:US
Mailing Address - Phone:203-560-5297
Mailing Address - Fax:
Practice Address - Street 1:10 BEE ST APT C
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5854
Practice Address - Country:US
Practice Address - Phone:203-560-5297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4190-NU-NU133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered