Provider Demographics
NPI:1710918552
Name:MARTIN, TONYA (PA)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 E ROY FURMAN HWY STE 105
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-8084
Mailing Address - Country:US
Mailing Address - Phone:724-627-8080
Mailing Address - Fax:724-852-7510
Practice Address - Street 1:343 E ROY FURMAN HWY STE 105
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8084
Practice Address - Country:US
Practice Address - Phone:724-627-8080
Practice Address - Fax:724-852-7510
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051328363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant