Provider Demographics
NPI:1922616093
Name:MARS, ALLISON (MS RD LDN)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:MARS
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-1415
Mailing Address - Country:US
Mailing Address - Phone:781-690-1683
Mailing Address - Fax:
Practice Address - Street 1:119 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-1415
Practice Address - Country:US
Practice Address - Phone:781-690-1683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3764133V00000X
86056435133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered