Healthcare Provider Details

I. General information

NPI: 1760102214
Provider Name (Legal Business Name): GAIL MARTIN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 OGLETOWN STANTON RD
NEWARK DE
19713-4169
US

IV. Provider business mailing address

201 TIMBER JUMP LN
MEDIA PA
19063-1133
US

V. Phone/Fax

Practice location:
  • Phone: 551-697-7552
  • Fax:
Mailing address:
  • Phone: 551-697-7552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberB1-0011340
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: