Provider Demographics
NPI:1417169087
Name:POPE, MARTHA HALEY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:HALEY
Last Name:POPE
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 1:1013 WOODSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-5171
Mailing Address - Country:US
Mailing Address - Phone:225-761-0612
Mailing Address - Fax:225-769-2188
Practice Address - Street 1:1013 WOODSTONE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-5171
Practice Address - Country:US
Practice Address - Phone:225-761-0612
Practice Address - Fax:225-769-2188
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0070582080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1022438Medicaid
LAE41911Medicare UPIN