Provider Demographics
NPI:1942511431
Name:MARTIN, ANDREW JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:MARTIN
Suffix:
Gender:M
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 1:738 MORGAN RD
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-4335
Mailing Address - Country:US
Mailing Address - Phone:413-250-8650
Mailing Address - Fax:
Practice Address - Street 1:101 WASON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1140
Practice Address - Country:US
Practice Address - Phone:800-841-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4004363AM0700X, 363AM0700X
CT003230363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1093033OtherNCCPA
MAPA4004OtherMASSACHUSETTS BOARD OF REGISTRATION OF PHYSICIAN ASSISTANTS