| Organization Name: | PAX RIVER MEDICAL CLINIC, LLC |
| NPI Number: | 1083807085 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KATHERINE ANN MARTIN (OWNER) |
| Mailing Address: | 46940 S Shangri La Dr Suite #19 Lexington Park |
| State: | MD US |
| Postal Code: | 206531037 |
| Phone Number: | 3018638101 |
| Fax Number: | 3018638130 |
| NPI Enumeration Date: | 08/22/2007 |
| NPI Last Update Date: | 05/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | H0055958 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |