Provider Demographics
NPI:1154449338
Name:MARTIN, ERIN TAMAR (PA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:TAMAR
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:461 W HURON ST
Mailing Address - Street 2:NOMC SURGERY DEPARTMENT
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1601
Mailing Address - Country:US
Mailing Address - Phone:248-857-7314
Mailing Address - Fax:248-857-6793
Practice Address - Street 1:461 W HURON ST
Practice Address - Street 2:NOMC SURGERY DEPARTMENT
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1601
Practice Address - Country:US
Practice Address - Phone:248-857-7314
Practice Address - Fax:248-857-6793
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004651363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical