Provider Demographics
NPI:1346314291
Name:WASIAK, MARTA K (MD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:K
Last Name:WASIAK
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 1:1111 NE 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-5675
Mailing Address - Country:US
Mailing Address - Phone:352-351-2889
Mailing Address - Fax:352-351-9495
Practice Address - Street 1:3130 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4306
Practice Address - Country:US
Practice Address - Phone:352-571-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME820062084P0804X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000745500Medicaid
FL53132OtherBCBS FL
FL000745500Medicaid
FLBM018YMedicare PIN