Provider Demographics
NPI:1760414932
Name:MARTIN, JOANNA D (RD CDE)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:D
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-0789
Mailing Address - Country:US
Mailing Address - Phone:413-509-1000
Mailing Address - Fax:413-509-1003
Practice Address - Street 1:14 S WESTFIELD ST
Practice Address - Street 2:
Practice Address - City:FEEDING HILLS
Practice Address - State:MA
Practice Address - Zip Code:01030-2702
Practice Address - Country:US
Practice Address - Phone:413-786-2957
Practice Address - Fax:413-786-2956
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA344133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALD0027OtherBCBSMA
MAMT0173Medicare ID - Type Unspecified