Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | C54981 | CA |
N | 2080A0000X | Adolescent Medicine | MD048496L | PA |
NPI | 1063524460 |
---|---|
Provider Name | Anne Catherine Martin-Ko |
First Address | Ukiah, CA 95482-4533 |
Second Address | Ukiah, CA 95482-4533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 13/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000853A | UPMC (01) | PA |
0012644510003OU | (05) | PA |
0014521480001 | (05) | PA |
0366976 | CIGNA (01) | PA |
42469 | AETNA (01) | PA |
575394 | HIGHMARK (01) | PA |
90923 | (05) | PA |
F00160 | (02) | PA |