Provider Demographics
NPI:1497731434
Name:MARTIN, CHARITY A (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7811 N POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3209
Mailing Address - Country:US
Mailing Address - Phone:336-759-0700
Mailing Address - Fax:336-759-2226
Practice Address - Street 1:7811 N POINT BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3209
Practice Address - Country:US
Practice Address - Phone:336-759-0700
Practice Address - Fax:336-759-2226
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103340363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0101909OtherUNITED HEALTHCARE
NCB4065OtherMEDCOST
NCP16603Medicare UPIN
NCB4065OtherMEDCOST