Individual
REGINA MARIE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
5401 OLD COURT RD, RANDALLSTOWN, MD 21133-5103
(410) 521-2200
(410) 496-7541
Mailing address
4231 NORTHWOODS TRAIL, HAMPSTEAD, MD 21074
(410) 374-9391
(410) 374-1866
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0003356
MD
Other
Enumeration date
12/05/2006
Last updated
09/03/2009
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