Provider Demographics
NPI:1831415256
Name:MARTIN, RAYMOND EDWARD III (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:EDWARD
Last Name:MARTIN
Suffix:III
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:58 OLD NORTH RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01098-9753
Mailing Address - Country:US
Mailing Address - Phone:413-238-5511
Mailing Address - Fax:413-238-5358
Practice Address - Street 1:58 OLD NORTH RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MA
Practice Address - Zip Code:01098-9753
Practice Address - Country:US
Practice Address - Phone:413-238-5511
Practice Address - Fax:413-238-5358
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN280297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily