Provider Demographics
NPI:1467424770
Name:MARTIN, MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
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:PO BOX 22696
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37422-2696
Mailing Address - Country:US
Mailing Address - Phone:423-499-8877
Mailing Address - Fax:423-499-8085
Practice Address - Street 1:2051B HAMILL RD
Practice Address - Street 2:SUITE 108
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4085
Practice Address - Country:US
Practice Address - Phone:423-499-8877
Practice Address - Fax:423-499-8085
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000691743BMedicaid
TNP00338526OtherRAILROAD MEDICARE
TN3077317Medicaid
TNP00338526OtherRAILROAD MEDICARE
GA000691743BMedicaid