1518029933 NPI number — MRS. KATHRYN R MARTIN P.A.-C

Table of content: MRS. KATHRYN R MARTIN P.A.-C (NPI 1518029933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518029933 NPI number — MRS. KATHRYN R MARTIN P.A.-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
KATHRYN
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C
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:
1518029933
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 FIRST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLEBROOK
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03576-3128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-331-0500
Provider Business Mailing Address Fax Number:
603-237-8100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
136 COUNTY FARM ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST STEWARDSTOWN
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-246-3321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2006

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: 363A00000X , with the licence number:  OA000044L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 0906 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3079443 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".