MEDICARE: MS. HOLLY R MARTIN PA-C

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	103120	NC

General Provider Information

NPI Number	:	1760488035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLY R MARTIN PA-C

Provider Business Mailing Address
First Line	:	10931 RAVEN RIDGE RD
Second Line	:	STE 101
City	:	RALEIGH
State	:	NC
Zip	:	27614-6499
Country	:	US
Telephone Number	:	919-870-6600
Fax Number	:	919-870-1610

Provider Business Practice Location Address
First Line	:	10931 RAVEN RIDGE RD
Second Line	:	STE 101
City	:	RALEIGH
State	:	NC
Zip	:	27614-6499
Country	:	US
Telephone Number	:	919-870-6600
Fax Number	:	919-870-1610

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	12/07/2016

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