1235322629 NPI number — DR. KATHERINE BROOKE MARTIN MD

Table of content: DR. KATHERINE BROOKE MARTIN MD (NPI 1235322629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235322629 NPI number — DR. KATHERINE BROOKE MARTIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
KATHERINE
Provider Middle Name:
BROOKE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235322629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1605 N CEDAR CREST BLVD STE 411
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18104-2323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-969-1914
Provider Business Mailing Address Fax Number:
610-969-3951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1251 S CEDAR CREST BLVD STE 202A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18103-6214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-402-5766
Provider Business Practice Location Address Fax Number:
610-402-5763
Provider Enumeration Date:
08/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0015X , with the licence number:  MD452128 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: MD452128 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)