Provider Demographics
NPI:1720098668
Name:MARTIN, GLORIA G (WOMANS HEALTH)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:G
Last Name:MARTIN
Suffix:
Gender:F
Credentials:WOMANS HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 HAMILTON BLVD
Mailing Address - Street 2:
Mailing Address - City:TREXLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18087-9100
Mailing Address - Country:US
Mailing Address - Phone:610-481-0481
Mailing Address - Fax:610-481-0486
Practice Address - Street 1:28 N 7TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2110
Practice Address - Country:US
Practice Address - Phone:610-481-0481
Practice Address - Fax:610-481-0486
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159042207Q00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300709OtherCMSP-GROUP
MA1300709Medicaid
MA58497OtherCMSP
MAY10141OtherBCBS-GROUP
MANP4352Medicare ID - Type UnspecifiedPART B
MAY10141OtherBCBS-GROUP
MA1300709OtherCMSP-GROUP
MA58497OtherCMSP
MAY10141Medicare ID - Type UnspecifiedPART B-GROUP