Provider Demographics
NPI:1275690786
Name:WOOTEN, MARTHA A (ACA, MA)
Entity Type:Individual
Prefix:MISS
First Name:MARTHA
Middle Name:A
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:ACA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7544 HOLABIRD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-2104
Mailing Address - Country:US
Mailing Address - Phone:410-284-2889
Mailing Address - Fax:
Practice Address - Street 1:7544 HOLABIRD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-2104
Practice Address - Country:US
Practice Address - Phone:410-284-2889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01883237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDL265OtherBLUE CROSS BLUE SHIELD