Provider Demographics
NPI:1871507285
Name:MARTIN, MARYANNE (MD)
Entity Type:Individual
Prefix:
First Name:MARYANNE
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 1:118 LIMESTONE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648
Mailing Address - Country:US
Mailing Address - Phone:814-696-3895
Mailing Address - Fax:
Practice Address - Street 1:ALTOONA REGIONAL HEALTH SYSTEM BEHAVIORAL HEALTH SERVIC
Practice Address - Street 2:620 HOWARD AVE
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4899
Practice Address - Country:US
Practice Address - Phone:814-889-2141
Practice Address - Fax:814-889-7999
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035206E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E63364Medicare UPIN
038376Medicare ID - Type Unspecified