Healthcare Provider Details

I. General information

NPI: 1750162129
Provider Name (Legal Business Name): SAMANTHA MARTIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 N DUKE ST STE 110
LANCASTER PA
17602-2374
US

IV. Provider business mailing address

1272 POPLAR ST
EAST EARL PA
17519-9462
US

V. Phone/Fax

Practice location:
  • Phone: 717-682-2592
  • Fax:
Mailing address:
  • Phone: 171-768-2259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0011969
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA067562
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: