Provider Demographics
NPI:1114933793
Name:MARTINDALE, CHRISTINE M (PA)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:M
Last Name:MARTINDALE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34431 KING STREET ROW
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4787
Mailing Address - Country:US
Mailing Address - Phone:302-645-2666
Mailing Address - Fax:302-645-6448
Practice Address - Street 1:34431 KING STREET ROW
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958
Practice Address - Country:US
Practice Address - Phone:302-645-2666
Practice Address - Fax:302-645-6448
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0001136363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS70600Medicare UPIN
NC2750064Medicare ID - Type Unspecified