Provider Demographics
NPI:1164490157
Name:MARTIN, JO MYERS (MD)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:MYERS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JO
Other - Middle Name:MYERS
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:
Practice Address - Street 1:30 SHADY LN
Practice Address - Street 2:
Practice Address - City:WHITE STONE
Practice Address - State:VA
Practice Address - Zip Code:22578-2601
Practice Address - Country:US
Practice Address - Phone:804-435-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101222830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF78629Medicare UPIN
VA5624941Medicaid
VAP00689757Medicare PIN
VAC09816OtherMEDICARE GROUP NUMBER
VAMC11976Medicare PIN
VAMC11985Medicare PIN
VA361345OtherANTHEM BCBS
VAMC11984Medicare PIN
VA00X033C01Medicare ID - Type Unspecified