Provider Demographics
NPI:1942249420
Name:MARTIN, BRIAN ANDREW (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ANDREW
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:1842 KRYSTLE DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-4149
Mailing Address - Country:US
Mailing Address - Phone:717-399-9094
Mailing Address - Fax:
Practice Address - Street 1:2150 NOLL DR STE 100
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-7605
Practice Address - Country:US
Practice Address - Phone:717-299-8933
Practice Address - Fax:717-295-1349
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA002521L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical