Provider Demographics
NPI:1366465205
Name:MARTIN, NANCY C (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:C
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 1:824 ELMWOOD PARK BLVD.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-3352
Mailing Address - Country:US
Mailing Address - Phone:504-818-2525
Mailing Address - Fax:504-818-0492
Practice Address - Street 1:824 ELMWOOD PARK BLVD.
Practice Address - Street 2:SUITE 210
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-3352
Practice Address - Country:US
Practice Address - Phone:504-818-2525
Practice Address - Fax:504-818-0492
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018650207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1919586Medicaid
LA1919586Medicaid
LA5N651Medicare ID - Type Unspecified