Provider Demographics
NPI:1982787511
Name:MARTIN-NAAR, MARYLYN A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYLYN
Middle Name:A
Last Name:MARTIN-NAAR
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 1:106 W DALLAS RD
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164-2103
Mailing Address - Country:US
Mailing Address - Phone:910-690-8033
Mailing Address - Fax:
Practice Address - Street 1:106 W DALLAS RD
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NC
Practice Address - Zip Code:28164-2103
Practice Address - Country:US
Practice Address - Phone:910-690-8033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC202003998207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1982787511Medicaid