# PAX RIVER MEDICAL CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083807085
- **Authorized official:** DR. KATHERINE ANN MARTIN DO (OWNER)
- **Authorized official phone:** (301) 863-8101

## Contact information

- **Practice address:** 46940 S SHANGRI LA DR, SUITE \#19, LEXINGTON PARK, MD 20653-1037
- **Practice address phone:** (301) 863-8101
- **Practice address fax:** (301) 863-8130
- **Mailing address:** 46940 S SHANGRI LA DR, SUITE \#19, LEXINGTON PARK, MD 20653-1037
- **Mailing address phone:** (301) 863-8101
- **Mailing address fax:** (301) 863-8130

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | H0055958 | MD | Yes |

## Other

- **Enumeration date:** 08/22/2007
- **Last updated:** 05/09/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 011218600 | — | MD |
| 01 | — | 1437267986 | INDIVIDUAL NPI \# | MD |