Provider Demographics
NPI:1639231384
Name:SARASUA, MARTHA MARION (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:MARION
Last Name:SARASUA
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 1:6706 N 9TH AVE
Mailing Address - Street 2:SUITE A4
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-9303
Mailing Address - Country:US
Mailing Address - Phone:850-478-2339
Mailing Address - Fax:850-478-2372
Practice Address - Street 1:6706 N 9TH AVE
Practice Address - Street 2:SUITE A4
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-9303
Practice Address - Country:US
Practice Address - Phone:850-478-2339
Practice Address - Fax:850-478-2372
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00611402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370354100Medicaid
FLE75606Medicare UPIN
FL370354100Medicaid