Organization
GREAT COVE INTEGRATIVE MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHARON EUNICE MARTIN MD PHD (OWNER)
(717) 485-4131
Entity
Organization
Contact information
Practice address
124 S 2ND ST, MC CONNELLSBURG, PA 17233-1446
(717) 485-4131
(717) 485-3394
Mailing address
124 S 2ND ST, MC CONNELLSBURG, PA 17233-1446
(717) 485-4131
(717) 485-3394
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD067389L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017504800005
—
PA
01
—
133213
HIGHMARK BLUE SHIELD
PA
01
—
5008657
CAPITAL BLUE CROSS
PA
Enumeration date
02/28/2007
Last updated
04/20/2012
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