Provider Demographics
NPI:1609393487
Name:GRAHAM, MARTA (RDN, LD)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8367 WINDING TRAIL PL
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9553
Mailing Address - Country:US
Mailing Address - Phone:513-460-0912
Mailing Address - Fax:
Practice Address - Street 1:8367 WINDING TRAIL PL
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9553
Practice Address - Country:US
Practice Address - Phone:513-460-0912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD5506133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered