Provider Demographics
NPI:1407965429
Name:LOUIS, MARTHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:LOUIS
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 1:8900 VAN WYCK EXPY
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2897
Mailing Address - Country:US
Mailing Address - Phone:718-206-6808
Mailing Address - Fax:631-454-4163
Practice Address - Street 1:12901 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-3119
Practice Address - Country:US
Practice Address - Phone:718-738-8800
Practice Address - Fax:718-738-9876
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224789174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist