Provider Demographics
NPI:1881691277
Name:MARTIN, KARA M (MD)
Entity type:Individual
Prefix:MS
First Name:KARA
Middle Name:M
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 1:4204 MURDOCKSVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376-8871
Mailing Address - Country:US
Mailing Address - Phone:910-255-0055
Mailing Address - Fax:910-255-0060
Practice Address - Street 1:4204 MURDOCKSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376-8871
Practice Address - Country:US
Practice Address - Phone:910-255-0055
Practice Address - Fax:910-255-0060
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600629207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN0062AMedicaid
NC54479OtherBCBS
NC8954479Medicaid
NC2225603OtherMEDICARE PTAN END DATE 2/25/2009
NC2225603BOtherMEDICARE PTAN START DATE 2/26/2009
NC660001954OtherMEDICARE RAILROAD PIN
NCG29335Medicare UPIN