Provider Demographics
NPI:1710181052
Name:MARTIN, PAULA (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
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 1:235 CYPRESS ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6776
Mailing Address - Country:US
Mailing Address - Phone:617-697-5183
Mailing Address - Fax:617-604-4584
Practice Address - Street 1:235 CYPRESS ST STE 1B
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6776
Practice Address - Country:US
Practice Address - Phone:617-697-5183
Practice Address - Fax:617-604-4584
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA815642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF41111Medicare UPIN