MEDICARE: DR. EDWINA LATASHA MARTIN PH.D.

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	103TC0700X	Clinical Psychologist	35204	TX

General Provider Information

NPI Number	:	1932605565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWINA LATASHA MARTIN PH.D.

Provider Business Mailing Address
First Line	:	PSC 402 BOX 106
Second Line	:
City	:	APO
State	:	AE
Zip	:	09180-0002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	LANDSTUHL REGIONAL MEDICAL CENTER
Second Line	:	UNIT 33100
City	:	APO
State	:	AE
Zip	:	09180
Country	:	US
Telephone Number	:	315-634-3272
Fax Number	:

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

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	06/18/2026

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