Provider Demographics
NPI:1780726232
Name:WALKER, MARTHA (PA)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05476-1153
Mailing Address - Country:US
Mailing Address - Phone:802-255-5500
Mailing Address - Fax:802-255-5509
Practice Address - Street 1:44 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHFORD
Practice Address - State:VT
Practice Address - Zip Code:05476-1153
Practice Address - Country:US
Practice Address - Phone:802-255-5500
Practice Address - Fax:802-255-5509
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011732363AM0700X
VT055-0030921363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTP00668428Medicare PIN
VT000624301Medicare PIN
VTVN0879Medicare PIN