Provider Demographics
NPI:1417012923
Name:PHILION, MARTHA S (NP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:S
Last Name:PHILION
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 1:101 RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3613
Mailing Address - Country:US
Mailing Address - Phone:518-812-2944
Mailing Address - Fax:518-761-1163
Practice Address - Street 1:101 RIDGE ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3613
Practice Address - Country:US
Practice Address - Phone:518-812-2944
Practice Address - Fax:518-761-1163
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF360038363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01218395Medicaid
NY33531EMedicare ID - Type Unspecified