Healthcare Provider Details

I. General information

NPI: 1538541628
Provider Name (Legal Business Name): JULIE MARTIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 OYSTER POINT RD
NEWPORT NEWS VA
23606-4570
US

IV. Provider business mailing address

680 OYSTER POINT RD
NEWPORT NEWS VA
23606-4570
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-4851
  • Fax:
Mailing address:
  • Phone: 577-668-4851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110005403
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-05783
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: