Individual
BONNIE R MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
530 LORING AVE, SUITE 201, SALEM, MA 01970-4256
(978) 744-7890
Mailing address
530 LORING AVE, SUITE 201, SALEM, MA 01970-4256
(978) 744-7890
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
123677
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39470
HARVARD PILGRIM
MD
01
—
706660
TUFTS
MA
01
—
LD0127
BLUE CROSS BLUE SHIELD
MA
Enumeration date
02/28/2007
Last updated
07/08/2007
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