Provider Demographics
NPI:1629119342
Name:MARTIN, AMY C (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C
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 1:3010 BERKMAR DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1443
Mailing Address - Country:US
Mailing Address - Phone:434-964-9430
Mailing Address - Fax:434-964-0199
Practice Address - Street 1:3010 BERKMAR DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1443
Practice Address - Country:US
Practice Address - Phone:434-964-9430
Practice Address - Fax:434-964-0199
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001363363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110001363OtherSTATE LICENSE
VA0110001363OtherSTATE LICENSE