Healthcare Provider Details

I. General information

NPI: 1902473788
Provider Name (Legal Business Name): ERIN MICELLE MC BERRY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN MICHELLE MARTINI

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 FENTON ST STE 1200
SILVER SPRING MD
20910-3808
US

IV. Provider business mailing address

8665 GEORGIA AVE
SILVER SPRING MD
20910-3405
US

V. Phone/Fax

Practice location:
  • Phone: 240-839-4363
  • Fax: 301-495-0318
Mailing address:
  • Phone: 240-839-4363
  • Fax: 301-495-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX3540
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: