Provider Demographics
NPI:1942242607
Name:LOZANO, MARTHA BLAKE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:BLAKE
Last Name:LOZANO
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 1:5030 PENNBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-8272
Mailing Address - Country:US
Mailing Address - Phone:804-275-9209
Mailing Address - Fax:
Practice Address - Street 1:5030 PENNBROOK DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-8272
Practice Address - Country:US
Practice Address - Phone:804-275-9209
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA-00923363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical