Provider Demographics
NPI:1417908518
Name:MARTIN, CYNTHIA A (CRNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:ANN
Other - Last Name:GOULD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1803 MT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3051
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:212 ROSEDALE DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:PA
Practice Address - Zip Code:17345-1023
Practice Address - Country:US
Practice Address - Phone:717-851-5503
Practice Address - Fax:717-851-1905
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008018363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA210560OtherJOHNS HOPKINS
MD930955OtherCAREFIRST MD BCBS
PA50078166OtherCAPITAL BLUE CROSS-WMG
PA1876086OtherHIGHMARK BLUE SHIELD
PA1551757OtherGATEWAY-WMG
PAP84019Medicare UPIN
PA125668FLTMedicare PIN