Provider Demographics
NPI: | 1356349906 |
---|---|
Name: | MARTIN, CATHERINE STROUD (DO) |
Entity type: | Individual |
Prefix: | MS |
First Name: | CATHERINE |
Middle Name: | STROUD |
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: | 103 HOLLOW LN |
Mailing Address - Street 2: | |
Mailing Address - City: | ONEIDA |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37841-5827 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 423-215-3753 |
Mailing Address - Fax: | 423-214-1004 |
Practice Address - Street 1: | VA LEXINGTON HEALTH CARE |
Practice Address - Street 2: | 300 MEDPARK DRIVE |
Practice Address - City: | SOMERSET |
Practice Address - State: | KY |
Practice Address - Zip Code: | 42503 |
Practice Address - Country: | US |
Practice Address - Phone: | 606-676-0786 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-07-08 |
Last Update Date: | 2024-12-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | DO 1096 | 207V00000X |
TN | DO1096 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 3304161 | Medicaid | |
KY | 64713316 | Medicaid | |
TN | 3304161 | Medicaid | |
3304169 | Medicare PIN |