Provider Demographics
NPI:1578345427
Name:MARTIN, CHRISTINE ELIZABETH (PA-C)
Entity Type:Individual
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First Name:CHRISTINE
Middle Name:ELIZABETH
Last Name:MARTIN
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1315 S WALTER REED DR APT 101
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-4934
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14904 RICHMOND HWY STE 203
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3908
Practice Address - Country:US
Practice Address - Phone:703-492-6660
Practice Address - Fax:703-492-6661
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2024-01-09
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Provider Licenses
StateLicense IDTaxonomies
VA0110009637363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant