Healthcare Provider Details

I. General information

NPI: 1295063329
Provider Name (Legal Business Name): TANIKA V. MARTIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 16TH ST
SILVER SPRING MD
20910-2261
US

IV. Provider business mailing address

PO BOX 759047
BALTIMORE MD
21275-9047
US

V. Phone/Fax

Practice location:
  • Phone: 301-960-4682
  • Fax: 301-960-4683
Mailing address:
  • Phone: 804-968-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0004127
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: