Provider Demographics
NPI:1154324267
Name:MARTIN-SMITH, VICTORIA A (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:A
Last Name:MARTIN-SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W RAMPART ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8846
Mailing Address - Country:US
Mailing Address - Phone:317-398-0121
Mailing Address - Fax:317-398-0538
Practice Address - Street 1:2120 INTELLIPLEX DR
Practice Address - Street 2:STE 102
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8547
Practice Address - Country:US
Practice Address - Phone:317-421-5713
Practice Address - Fax:317-825-5321
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050948A2083B0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200183740Medicaid
IN000000521375OtherANTHEM BCBS
IN200183740Medicaid
IN941000WWWWMedicare PIN