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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