Provider Demographics
NPI:1295266534
Name:MUSTROPH, MARTINA LAETITIA (MD, PHD)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:LAETITIA
Last Name:MUSTROPH
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 8TH ST NE APT 2
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4218
Mailing Address - Country:US
Mailing Address - Phone:404-993-2808
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF NEUROSURGERY 1365 CLIFTON ROAD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-0001
Practice Address - Country:US
Practice Address - Phone:404-993-2808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA292143207T00000X
390200000X
GA99696207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program