Provider Demographics
NPI:1720541048
Name:MARTIN, ELAINE CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:CHRISTINE
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 1:2301 CHAMPLAIN ST NW APT 314
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-8703
Mailing Address - Country:US
Mailing Address - Phone:774-266-6084
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DR S # 2
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:800-263-9547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program