Provider Demographics
NPI:1255470084
Name:MARTIN, LYNDA J G (CRNA)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:J G
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:J
Other - Last Name:GILLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:163 LIBBEY PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3118
Mailing Address - Country:US
Mailing Address - Phone:781-337-4224
Mailing Address - Fax:781-335-0429
Practice Address - Street 1:163 LIBBEY PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3118
Practice Address - Country:US
Practice Address - Phone:781-337-4224
Practice Address - Fax:781-335-0429
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA172860367500000X
MARN172860163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA0915Medicare PIN
MANA091501Medicare PIN