Provider Demographics
NPI:1538994454
Name:MARTIN, EMILY (RD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 MEDIA LINE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQ
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4524
Mailing Address - Country:US
Mailing Address - Phone:484-557-3450
Mailing Address - Fax:
Practice Address - Street 1:514 MEDIA LINE RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQ
Practice Address - State:PA
Practice Address - Zip Code:19073-4524
Practice Address - Country:US
Practice Address - Phone:484-557-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA008671133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered