Provider Demographics
NPI:1205287786
Name:KING, MARTHA ANNE DEBERRY
Entity type:Individual
Prefix:
First Name:MARTHA ANNE
Middle Name:DEBERRY
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 GARDENIA RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5212
Mailing Address - Country:US
Mailing Address - Phone:843-687-9967
Mailing Address - Fax:
Practice Address - Street 1:1514 GARDENIA RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5212
Practice Address - Country:US
Practice Address - Phone:843-687-9967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL39874207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology