Provider Demographics
NPI:1962407858
Name:MARTIN, CYNTHIA L (NP)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:L
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:540 S GOVERNORS AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3530
Mailing Address - Country:US
Mailing Address - Phone:302-744-7994
Mailing Address - Fax:302-744-7993
Practice Address - Street 1:540 S GOVERNORS AVE
Practice Address - Street 2:STE 100
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3530
Practice Address - Country:US
Practice Address - Phone:302-744-7994
Practice Address - Fax:302-744-7993
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELB0000254363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00792184EMedicaid
GA50BBHBBMedicare PIN
GAS50199Medicare UPIN