Healthcare Provider Details

I. General information

NPI: 1417884339
Provider Name (Legal Business Name): ANN MARIE MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE
BOSTON MA
02215
US

IV. Provider business mailing address

30 SHEFFIELD DR
BRAINTREE MA
02184-4000
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-3000
  • Fax:
Mailing address:
  • Phone: 339-235-5946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2354288
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: