Provider Demographics
NPI:1467424903
Name:MARTIN, JENA CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:CATHERINE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:CATHERINE
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2800 10TH AVE S STE 2200
Mailing Address - Street 2:HOSPITAL PATHOLOGY ASSOC
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1311
Mailing Address - Country:US
Mailing Address - Phone:612-767-8370
Mailing Address - Fax:612-767-8376
Practice Address - Street 1:2800 10TH AVE S STE 2200
Practice Address - Street 2:HOSPITAL PATHOLOGY ASSOC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1311
Practice Address - Country:US
Practice Address - Phone:612-767-8370
Practice Address - Fax:612-767-8376
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46933207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MN953148300Medicaid
IAENROLLEDMedicaid
WI35272800Medicaid
MN953148300Medicaid
WI35272800Medicaid
MNENROLLEDMedicaid