1235138793 NPI number — MRS. AMY ARBAUGH MARTIN MS, CRNP

Table of content: MRS. AMY ARBAUGH MARTIN MS, CRNP (NPI 1235138793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235138793 NPI number — MRS. AMY ARBAUGH MARTIN MS, CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
AMY
Provider Middle Name:
ARBAUGH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, CRNP
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:
1235138793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3904 GRAVE RUN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLERS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21102-2218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-536-3527
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 DISTILLERY RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21157-5344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-876-4800
Provider Business Practice Location Address Fax Number:
410-871-3219
Provider Enumeration Date:
07/18/2005

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: 363LA2200X , with the licence number:  R107890 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: R107890 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 158204600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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