MEDICARE: MARIA MARTINEZ PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	25MP00358300	NJ

General Provider Information

NPI Number	:	1619366317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA MARTINEZ PA

Provider Business Mailing Address
First Line	:	24 PARTRIDGE CT
Second Line	:
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-9461
Country	:	US
Telephone Number	:	856-451-1746
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 S LAUREL ST
Second Line	:
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-1946
Country	:	US
Telephone Number	:	856-451-4700
Fax Number	:	856-794-7183

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2015
Last Update Date	:	01/19/2015

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Directions to “ MARIA MARTINEZ PA” Practice Location

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