Provider Demographics
NPI:1942283296
Name:MARTIN, PAULA (DO)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5715
Mailing Address - Fax:540-224-5684
Practice Address - Street 1:22890 VIRGIL H GOODE HWY
Practice Address - Street 2:
Practice Address - City:BOONES MILL
Practice Address - State:VA
Practice Address - Zip Code:24065-4989
Practice Address - Country:US
Practice Address - Phone:540-334-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102-201419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010135893Medicaid
VA006700C95Medicare ID - Type Unspecified
VAI 07902Medicare UPIN