Healthcare Provider Details

I. General information

NPI: 1801892948
Provider Name (Legal Business Name): JAMES ALLEN MARTIN RPAC,ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 SARATOGA RD
GLENVILLE NY
12302-4108
US

IV. Provider business mailing address

133 SARATOGA RD APT. T-05
GLENVILLE NY
12302-4108
US

V. Phone/Fax

Practice location:
  • Phone: 716-984-9309
  • Fax:
Mailing address:
  • Phone: 716-984-9309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1330
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9242972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: