Healthcare Provider Details

I. General information

NPI: 1134106750
Provider Name (Legal Business Name): MARTINA MARIE SCHULZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 TOLLGATE RD WARWICK PSYCH CENTER
WARWICK RI
02886
US

IV. Provider business mailing address

120 CENTERVILLE RD WARWICK PSYCH CENTER
WARWICK RI
02886-4336
US

V. Phone/Fax

Practice location:
  • Phone: 401-621-8700
  • Fax: 401-621-8705
Mailing address:
  • Phone: 401-738-3730
  • Fax: 401-738-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00154
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: