Provider Demographics
NPI:1073629663
Name:MARTIN, PAMELA Y (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:Y
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11889
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24506-1889
Mailing Address - Country:US
Mailing Address - Phone:434-947-3944
Mailing Address - Fax:434-544-2316
Practice Address - Street 1:2215 LANDOVER PL
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2115
Practice Address - Country:US
Practice Address - Phone:434-947-3944
Practice Address - Fax:434-544-2316
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00368766OtherMEDICARE RAILROAD CARRIER
VAP00368766OtherMEDICARE RAILROAD CARRIER
VA011820M68Medicare PIN