Provider Demographics
NPI:1639205529
Name:ABERRA, MARTHA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:
Last Name:ABERRA
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 1:3100 S MANCHESTER ST APT 922
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2717
Mailing Address - Country:US
Mailing Address - Phone:703-585-8567
Mailing Address - Fax:703-933-3434
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2976
Practice Address - Country:US
Practice Address - Phone:202-877-9119
Practice Address - Fax:202-877-7190
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002124363A00000X
DCPA30085363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS589Medicare PIN