Provider Demographics
NPI:1548617558
Name:MARTIN, LORIE ANN (PAC)
Entity Type:Individual
Prefix:
First Name:LORIE
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:LORIE
Other - Middle Name:ANN
Other - Last Name:HOLLISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:320 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:412-359-3255
Mailing Address - Fax:412-330-5522
Practice Address - Street 1:320 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-359-3255
Practice Address - Fax:412-330-5522
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001950L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant