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Organization
PAX RIVER MEDICAL CLINIC, LLC
Active
Organization
PAX RIVER MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHERINE ANN MARTIN DO (OWNER)
(301) 863-8101
Entity
Organization
Contact information
Practice address
46940 S SHANGRI LA DR, SUITE #19, LEXINGTON PARK, MD 20653-1037
(301) 863-8101
(301) 863-8130
Mailing address
46940 S SHANGRI LA DR, SUITE #19, LEXINGTON PARK, MD 20653-1037
(301) 863-8101
(301) 863-8130
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
H0055958
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011218600
—
MD
01
—
1437267986
INDIVIDUAL NPI #
MD
Enumeration date
08/22/2007
Last updated
05/09/2014
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