MEDICARE: DR. PAMELA ANN MARTIN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	241	NM

General Provider Information

NPI Number	:	1518956291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA ANN MARTIN PH.D.

Provider Business Mailing Address
First Line	:	2405 CALLE DE PANZA NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-3071
Country	:	US
Telephone Number	:	505-242-6672
Fax Number	:

Provider Business Practice Location Address
First Line	:	2405 CALLE DE PANZA NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-3071
Country	:	US
Telephone Number	:	505-242-6672
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	07/08/2007

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