Healthcare Provider Details

I. General information

NPI: 1720098668
Provider Name (Legal Business Name): GLORIA G MARTIN WOMANS HEALTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 N 7TH ST
STROUDSBURG PA
18360-2110
US

IV. Provider business mailing address

6900 HAMILTON BLVD
TREXLERTOWN PA
18087-9100
US

V. Phone/Fax

Practice location:
  • Phone: 610-481-0481
  • Fax: 610-481-0486
Mailing address:
  • Phone: 610-481-0481
  • Fax: 610-481-0486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number159042
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number159042
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: