MEDICARE: MARTHA HUNT KABRICH 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	363A00000X	Physician Assistant	001009468	NC
2	363A00000X	Physician Assistant	0010-09468	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	561122070	OTHER	NC	230306
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790334662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA HUNT KABRICH PA-C

Provider Business Mailing Address
First Line	:	PO BOX 751803
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1803
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 S HAWTHORNE RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-3912
Country	:	US
Telephone Number	:	336-718-8386
Fax Number	:	336-718-0290

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

Provider Enumeration Date	:	09/04/2019
Last Update Date	:	05/27/2025

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