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NPI Code Detail

MEDICARE: MADELEINE R MARTIN

MEDICARE: MADELEINE R MARTIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianDI172ME

General Provider Information

NPI Number : 1992807762
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELEINE R MARTIN
Provider Business Mailing Address
First Line : 1048 UNION ST
Second Line : SUITE 5
City : BANGOR
State : ME
Zip : 04401-8600
Country : US
Telephone Number : 207-945-5247
Fax Number : 207-992-2154
Provider Business Practice Location Address
First Line : 1012 UNION ST
Second Line :
City : BANGOR
State : ME
Zip : 04401-3060
Country : US
Telephone Number : 207-945-5247
Fax Number : 207-992-2154
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2006
Last Update Date : 08/27/2008

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Directions to “ MADELEINE R MARTIN ” Practice Location

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