Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | OA004442 | PA |
NPI | 1043707276 |
---|---|
Provider Name | Alyssa Martin |
First Address | Trenton, NJ 08690-3701 |
Second Address | Trenton, NJ 08690-3701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2018 |
Last Update Date | 14/01/2021 |