Healthcare Provider Details

I. General information

NPI: 1154384642
Provider Name (Legal Business Name): ROBERT CARRINGTON MARTIN II CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 SOUTH MAIN STREET
DANVILLE VA
24541
US

IV. Provider business mailing address

154 VIRGINIA AVENUE
DANVILLE VA
24541-3726
US

V. Phone/Fax

Practice location:
  • Phone: 434-799-2100
  • Fax:
Mailing address:
  • Phone: 434-791-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001078877
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024D78877
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: