Provider Demographics
NPI:1093754145
Name:MARTIN, BARBARA ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ELAINE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BARBARA
Other - Middle Name:ELAINE
Other - Last Name:DRUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5222 BALBOA AVE
Mailing Address - Street 2:FIFTH FLOOR
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6904
Mailing Address - Country:US
Mailing Address - Phone:858-292-7928
Mailing Address - Fax:858-292-0514
Practice Address - Street 1:5222 BALBOA AVE
Practice Address - Street 2:FIFTH FLOOR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6904
Practice Address - Country:US
Practice Address - Phone:858-292-7928
Practice Address - Fax:858-292-0514
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59728207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG59728OtherCA STATE LICENSE
CAE75083Medicare UPIN
CAWG59728BMedicare ID - Type UnspecifiedMEDICARE ID