Provider Demographics
NPI:1558111732
Name:MARTIN, ARDENNE (MD)
Entity Type:Individual
Prefix:
First Name:ARDENNE
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 1:2451 UNIVERSITY HOSPITAL DRIVE
Mailing Address - Street 2:MOORER BLDG. ROOM 120
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36617-2300
Mailing Address - Country:US
Mailing Address - Phone:251-471-7786
Mailing Address - Fax:251-471-7884
Practice Address - Street 1:2451 UNIVERSITY HOSPITAL DRIVE
Practice Address - Street 2:MOORER BLDG. ROOM 120
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2300
Practice Address - Country:US
Practice Address - Phone:251-471-7786
Practice Address - Fax:251-471-7884
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program