Provider Demographics
NPI: | 1770720815 |
---|---|
Name: | MARTIN, FRANCES MARIAN (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | FRANCES |
Middle Name: | MARIAN |
Last Name: | MARTIN |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 225 CLEARFIELD AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | VIRGINIA BEACH |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23462-1815 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 757-457-5100 |
Mailing Address - Fax: | 757-961-3696 |
Practice Address - Street 1: | 740 S LIMESTONE STE B200 |
Practice Address - Street 2: | |
Practice Address - City: | LEXINGTON |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40536-1815 |
Practice Address - Country: | US |
Practice Address - Phone: | 859-257-3533 |
Practice Address - Fax: | 859-218-7693 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2009-01-12 |
Last Update Date: | 2024-05-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 010125754 | 208800000X |
KY | 58917 | 208800000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208800000X | Allopathic & Osteopathic Physicians | Urology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VA | VVG068A180 | Other | MEDICARE NSC |
FL | K3569 | Other | GROUP LRHSI MEDICARE # |
1497748743 | Other | GROUP LRHSI NPI # 1497748743 | |
FL | DA5786 | Other | LRHSI GROUP MCARE RR # |