Provider Demographics
NPI:1760450514
Name:HURLEY, MARTHA ANNE (DPM)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANNE
Last Name:HURLEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8389
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22404-8389
Mailing Address - Country:US
Mailing Address - Phone:540-371-2724
Mailing Address - Fax:540-371-5072
Practice Address - Street 1:195 FALCON DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-1930
Practice Address - Country:US
Practice Address - Phone:540-371-2724
Practice Address - Fax:540-371-5072
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000972213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010081998Medicaid
VA001633F76Medicare ID - Type Unspecified
VA010081998Medicaid