Individual provider Active NPI

Cynthia L Martin, NP

  • Nurse Practitioner
  • Dover, DE
National Provider Identifier
1962407858
Registry record updated Oct 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
LB0000254 Issued in DE
Practice address
540 S Governors Ave
Ste 100
Dover, DE 19904-3530
Phone
(302) 744-7994
Fax
(302) 744-7993
NPI assigned
Jun 16, 2005
Last updated
Oct 18, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X LB0000254 DE Primary

Addresses

Primary practice location

540 S Governors Ave
Ste 100
Dover, DE 19904-3530

Mailing address

540 S Governors Ave
Ste 100
Dover, DE 19904-3530
Phone (302) 744-7994

Other identifiers 1

IdentifierTypeStateIssuer
00792184EMedicaidGA

Other names 1

  • Mrs. Cynthia L Martin Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120710000356 DE Practitioner - Nurse Practitioner 2961538509 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
LB0000254DEMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bayhealth Medical Center, Inc. CurrentSince Jul 1, 2019 Accepting new patients
Bayhealth Medical Center, Inc CurrentSince Jul 1, 2019 Accepting new patients
Bayhealth Medical Center, Inc CurrentSince Dec 18, 2017 Accepting new patients

Locations

640 S State St
Dover, DE 19901
Phone (302) 744-4700

100 Wellness Way
Milford, DE 19963
Phone (302) 422-3311

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318896000000",
    "number": "1962407858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 S GOVERNORS AVE",
            "address_2": "STE 100",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199043530",
            "telephone_number": "302-744-7994",
            "fax_number": "302-744-7993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 S GOVERNORS AVE",
            "address_2": "STE 100",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199043530",
            "telephone_number": "302-744-7994",
            "fax_number": "302-744-7993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "CYNTHIA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-16",
        "last_updated": "2011-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "DE",
            "license": "LB0000254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00792184E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CYNTHIA",
            "last_name": "MARTIN",
            "middle_name": "L",
            "prefix": "MRS.",
            "credential": "NP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Dover, DE

Sources for this page

Verify at the official NPI Registry.