Healthcare Provider Details

I. General information

NPI: 1568608453
Provider Name (Legal Business Name): THOMAS K. MARTIN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 INDEPENDENCE DRIVE SPRING CITY V.A. OUTPATIENT CLINIC
SPRING CITY PA
19475
US

IV. Provider business mailing address

6098 OLD PHILADELPHIA PIKE
GAP PA
17527-9797
US

V. Phone/Fax

Practice location:
  • Phone: 610-948-0981
  • Fax:
Mailing address:
  • Phone: 717-442-4509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN227027L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: