Provider Demographics
NPI:1235195157
Name:FUNKHOUSER, MARTHA E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:E
Last Name:FUNKHOUSER
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 1:208 BUNN DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2851
Mailing Address - Country:US
Mailing Address - Phone:609-683-4999
Mailing Address - Fax:
Practice Address - Street 1:208 BUNN DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2851
Practice Address - Country:US
Practice Address - Phone:609-683-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06040900207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223777703OtherCOMMERCIAL INSURANCES
NJF08743Medicare UPIN
NJF08743Medicare UPIN