Provider Demographics
NPI:1467571216
Name:WALKUP, MARTHA Y (DO)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:Y
Last Name:WALKUP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1578 N GREENHILL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-2454
Mailing Address - Country:US
Mailing Address - Phone:615-509-3366
Mailing Address - Fax:615-773-4502
Practice Address - Street 1:1578 N GREENHILL RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-2454
Practice Address - Country:US
Practice Address - Phone:615-509-3366
Practice Address - Fax:615-773-4502
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO 05732083X0100X
TXH2087 DO2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4212957OtherBLUE CROSS BLUE SHIELD OF TN
TN3300071Medicare PIN
TN33000711Medicare PIN
TN103I084910Medicare PIN
TN103I088746Medicare PIN
TN33000713Medicare PIN
TN103I082986Medicare PIN
TN33000712Medicare PIN