Provider Demographics
NPI:1891701462
Name:WALDEN, MARTHA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:LEE
Last Name:WALDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARTHALEE
Other - Middle Name:
Other - Last Name:WALDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:106 WELLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1710
Mailing Address - Country:US
Mailing Address - Phone:513-428-2201
Mailing Address - Fax:513-428-2201
Practice Address - Street 1:106 WELLINGTON PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1710
Practice Address - Country:US
Practice Address - Phone:513-428-2201
Practice Address - Fax:513-428-2201
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01083399A2084P0800X
PAMD4696362084P0800X
KY318652084P0800X
ARE-129382084P0800X
NJ25MA107946002084P0800X
NC2020-004892084P0800X
OH35.0785652084P0800X
OH35 0785652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64318652Medicaid
IN201005520Medicaid
OH2243807Medicaid
OHE55953Medicare UPIN
IN201005520Medicaid
OH2243807Medicaid