Provider Demographics
NPI:1497248710
Name:SHARITZ, MARTHA WALTERS
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:WALTERS
Last Name:SHARITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 VIRGINIA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1185
Mailing Address - Country:US
Mailing Address - Phone:276-223-1430
Mailing Address - Fax:
Practice Address - Street 1:360 VIRGINIA AVE STE B
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1185
Practice Address - Country:US
Practice Address - Phone:276-223-1430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-006203363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical