Provider Demographics
NPI:1639106545
Name:MARTIN, PATRICIA M (NP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 DWIGHT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1863
Mailing Address - Country:US
Mailing Address - Phone:413-732-4478
Mailing Address - Fax:413-732-7059
Practice Address - Street 1:1777 DWIGHT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1863
Practice Address - Country:US
Practice Address - Phone:413-732-4478
Practice Address - Fax:413-732-7059
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118367363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P04879Medicare UPIN
MANP2392Medicare PIN
P00456579Medicare PIN