Provider Demographics
NPI:1417920224
Name:SEELEY, MARTHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:SEELEY
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 1:220 N RACE ST
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-2816
Mailing Address - Country:US
Mailing Address - Phone:270-627-2007
Mailing Address - Fax:877-782-7080
Practice Address - Street 1:220 N RACE ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-2816
Practice Address - Country:US
Practice Address - Phone:270-627-2007
Practice Address - Fax:877-782-7080
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64194251Medicaid
KY64194251Medicaid