MEDICARE: ANGELA SUSAN MARTIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	ME 54467	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10352	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780677591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA SUSAN MARTIN M.D.

Provider Business Mailing Address
First Line	:	3627 UNIVERSITY BLVD S
Second Line	:	SUITE 200
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4230
Country	:	US
Telephone Number	:	904-296-3200
Fax Number	:	904-296-0069

Provider Business Practice Location Address
First Line	:	3627 UNIVERSITY BLVD S
Second Line	:	SUITE 200
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4230
Country	:	US
Telephone Number	:	904-296-3200
Fax Number	:	904-296-0069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	01/26/2022

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