Provider Demographics
NPI:1235138793
Name:MARTIN, AMY ARBAUGH (MS, CRNP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ARBAUGH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3904 GRAVE RUN RD
Mailing Address - Street 2:
Mailing Address - City:MILLERS
Mailing Address - State:MD
Mailing Address - Zip Code:21102-2218
Mailing Address - Country:US
Mailing Address - Phone:443-536-3527
Mailing Address - Fax:
Practice Address - Street 1:10 DISTILLERY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5344
Practice Address - Country:US
Practice Address - Phone:410-876-4800
Practice Address - Fax:410-871-3219
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR107890363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD158204600Medicaid
MD158204600Medicaid