Provider Demographics
NPI:1689605537
Name:MARTIN, CHRISTINA K (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:K
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:K
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:6535 N CHARLES ST
Mailing Address - Street 2:SUITE 550
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5826
Mailing Address - Country:US
Mailing Address - Phone:410-494-1662
Mailing Address - Fax:410-494-1718
Practice Address - Street 1:6535 N CHARLES ST
Practice Address - Street 2:SUITE 550
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5826
Practice Address - Country:US
Practice Address - Phone:410-494-1662
Practice Address - Fax:410-494-1718
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR167118363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q53473Medicare UPIN
000LM565Medicare ID - Type Unspecified