Provider Demographics
NPI:1831121755
Name:BOXMAN, MARTIN A (CRNA)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:A
Last Name:BOXMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8121 HAWTHORNE LANE
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2211
Mailing Address - Country:US
Mailing Address - Phone:215-663-0855
Mailing Address - Fax:215-663-9535
Practice Address - Street 1:8121 HAWTHORNE LANE
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2211
Practice Address - Country:US
Practice Address - Phone:215-663-0855
Practice Address - Fax:215-663-9535
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-195616-L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA022844Medicare PIN