Provider Demographics
NPI:1700873585
Name:YODER MAUST, MARTHA L (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
Last Name:YODER MAUST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:LISE
Other - Last Name:YODER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3403 E RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-4744
Mailing Address - Country:US
Mailing Address - Phone:317-957-2000
Mailing Address - Fax:317-957-2050
Practice Address - Street 1:2340 E 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-2008
Practice Address - Country:US
Practice Address - Phone:317-957-2200
Practice Address - Fax:317-957-2220
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100350520Medicaid
IN264420UMedicare ID - Type Unspecified
INF02846Medicare UPIN