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Organization
SOUTHSIDE PEDIATRICS & ADULT CARE LLC
Active
Organization
SOUTHSIDE PEDIATRICS & ADULT CARE LLC
Active
Other names
Christa L Martin DBA South Side Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHRISTA MARTIN CRNP (OWNER)
(240) 513-6300
Entity
Organization
Contact information
Practice address
1185 MOUNT AETNA RD STE 200, HAGERSTOWN, MD 21740-6832
(240) 513-6300
Mailing address
1185 MOUNT AETNA RD STE 200, HAGERSTOWN, MD 21740-6832
(240) 513-6300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
193525
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053302455
INDIVIDUAL NPI
MD
Enumeration date
01/31/2018
Last updated
06/09/2022
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