Provider Demographics
NPI:1356906168
Name:MARIN, AMANDA G (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:G
Last Name:MARIN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:G
Other - Last Name:KOCHASIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1202 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7307
Mailing Address - Country:US
Mailing Address - Phone:910-341-1540
Mailing Address - Fax:910-431-4048
Practice Address - Street 1:8068 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9384
Practice Address - Country:US
Practice Address - Phone:910-796-7767
Practice Address - Fax:910-686-7159
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2025-02-19
Deactivation Date:2020-06-09
Deactivation Code:
Reactivation Date:2020-07-22
Provider Licenses
StateLicense IDTaxonomies
NC0010-14830363A00000X
PAMA060569363A00000X
PAOA004795363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant