Provider Demographics
NPI:1073747556
Name:MARTIN, KARA ELIZABETH (AUD)
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:ELIZABETH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1803
Mailing Address - Country:US
Mailing Address - Phone:434-799-6288
Mailing Address - Fax:434-797-3685
Practice Address - Street 1:2104 LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1424
Practice Address - Country:US
Practice Address - Phone:434-528-4245
Practice Address - Fax:434-528-3685
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001396231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA103248OtherMEDICARE PALMETTO GBA PTAN (AUDIOLOGY HEARING AID ASSOCIATES, INC.)
VAP01117663OtherMEDICARE RAILROAD PTAN - AUDIOLOGY HEARING AID ASSOCIATES, INC.
VA1073747556Medicaid
VAVAA103247OtherMEDICARE PALMETTO GBA PTAN (DANNY W. GNEWIKOW, PH.D., LLC)