Provider Demographics
NPI:1164260527
Name:MARTELL, LILLA (RLE, RME, CLT)
Entity type:Individual
Prefix:MS
First Name:LILLA
Middle Name:
Last Name:MARTELL
Suffix:
Gender:F
Credentials:RLE, RME, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 BOSTON POST RD STE 204
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-3016
Mailing Address - Country:US
Mailing Address - Phone:508-509-8359
Mailing Address - Fax:
Practice Address - Street 1:416 BOSTON POST RD STE 204
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3016
Practice Address - Country:US
Practice Address - Phone:508-509-8359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1694247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty