Healthcare Provider Details

I. General information

NPI: 1225065030
Provider Name (Legal Business Name): REGINA M MARTIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 ROTHSVILLE RD SUITE 200
LITITZ PA
17543-8215
US

IV. Provider business mailing address

2320 ROTHSVILLE RD SUITE 200
LITITZ PA
17543-8215
US

V. Phone/Fax

Practice location:
  • Phone: 717-721-4800
  • Fax: 717-626-1613
Mailing address:
  • Phone: 717-721-4800
  • Fax: 717-626-1613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA002367L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: