Provider Demographics
NPI:1689617888
Name:MARTIN, ANGELIA D (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELIA
Middle Name:D
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1607 E US HIGHWAY 136
Mailing Address - Street 2:NMC ALBANY CLINIC EAST
Mailing Address - City:ALBANY
Mailing Address - State:MO
Mailing Address - Zip Code:64402-8223
Mailing Address - Country:US
Mailing Address - Phone:660-726-3333
Mailing Address - Fax:660-726-3232
Practice Address - Street 1:1607 E US HIGHWAY 136
Practice Address - Street 2:NMC ALBANY CLINIC EAST
Practice Address - City:ALBANY
Practice Address - State:MO
Practice Address - Zip Code:64402-8223
Practice Address - Country:US
Practice Address - Phone:660-726-3333
Practice Address - Fax:660-726-3232
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2017-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO115802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203818505Medicaid
MO203818505Medicaid