Provider Demographics
NPI:1053528711
Name:MARR, TIMOTHY A (RD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:MARR
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05009-5004
Mailing Address - Country:US
Mailing Address - Phone:802-291-6200
Mailing Address - Fax:802-442-2137
Practice Address - Street 1:215 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05009-5004
Practice Address - Country:US
Practice Address - Phone:802-291-6200
Practice Address - Fax:802-442-2137
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0740000101133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered