Healthcare Provider Details

I. General information

NPI: 1891038949
Provider Name (Legal Business Name): HOLLY P. MARTIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY P. WILLIAMS PA-C

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3706 SOUTH MAIN STREET SUITE D
BLACKSBURG VA
24060
US

IV. Provider business mailing address

PO BOX 8310
ROANOKE VA
24014-0310
US

V. Phone/Fax

Practice location:
  • Phone: 540-443-3832
  • Fax: 540-443-9362
Mailing address:
  • Phone: 540-345-3556
  • Fax: 540-342-2193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110004192
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: