Healthcare Provider Details

I. General information

NPI: 1033104815
Provider Name (Legal Business Name): MARTHA ANDERSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 WESCOTT DR SUITE 103
FLEMINGTON NJ
08822-4677
US

IV. Provider business mailing address

9100 WESCOTT DR SUITE 103
FLEMINGTON NJ
08822-4677
US

V. Phone/Fax

Practice location:
  • Phone: 908-237-6919
  • Fax:
Mailing address:
  • Phone: 908-237-6919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00025600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: