Provider Demographics
NPI:1275631384
Name:MARTIN, SHELDA A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELDA
Middle Name:A
Last Name:MARTIN
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 1:3200 MACCORKLE AVENUE SE
Mailing Address - Street 2:CAMC OUTPATIENT CLINICS
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:304-388-5590
Mailing Address - Fax:304-388-8238
Practice Address - Street 1:4522 MACCORKLE AVE SE
Practice Address - Street 2:SUITE 3
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1840
Practice Address - Country:US
Practice Address - Phone:304-720-7305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6000115000Medicaid
H10908Medicare UPIN
WVMA4055331Medicare ID - Type Unspecified