Provider Demographics
NPI:1629001219
Name:KENT, MARTHA J (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
Last Name:KENT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6100 PAN AMERICAN FREEWAY, NE
Mailing Address - Street 2:SUITE 390
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3401
Mailing Address - Country:US
Mailing Address - Phone:505-823-1805
Mailing Address - Fax:505-823-1844
Practice Address - Street 1:6100 PAN AMERICAN FREEWAY, NE
Practice Address - Street 2:SUITE 390
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3401
Practice Address - Country:US
Practice Address - Phone:505-823-1805
Practice Address - Fax:505-823-1844
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2014-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM82-226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM31807Medicaid
NM31807Medicaid
D35750Medicare UPIN