Provider Demographics
NPI:1891713665
Name:MARTINEZ, MARIA (PA)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:MARTINEZ
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 1:2100 STANTONSBURG RD RM 252-A
Mailing Address - Street 2:P.O. BOX 6028
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2818
Mailing Address - Country:US
Mailing Address - Phone:252-847-3898
Mailing Address - Fax:252-847-6255
Practice Address - Street 1:2100 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2818
Practice Address - Country:US
Practice Address - Phone:252-847-4155
Practice Address - Fax:252-847-6255
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00042363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ70166Medicare UPIN
NC2766317Medicare ID - Type UnspecifiedPROVIDER NUMBER