Healthcare Provider Details

I. General information

NPI: 1972804243
Provider Name (Legal Business Name): KATE MARTIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATE EVANGELIST

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 EYE ST NW SUITE 800
WASHINGTON DC
20006-4007
US

IV. Provider business mailing address

1627 EYE ST NW SUITE 800
WASHINGTON DC
20006-4007
US

V. Phone/Fax

Practice location:
  • Phone: 202-660-0025
  • Fax: 202-660-0015
Mailing address:
  • Phone: 202-660-0025
  • Fax: 202-660-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.60182624
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-03315
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA031060
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: