Healthcare Provider Details

I. General information

NPI: 1104232289
Provider Name (Legal Business Name): MARTHA MONTGOMERY ROBINSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 TULANE AVE FL 5
NEW ORLEANS LA
70112-2600
US

IV. Provider business mailing address

8405 NUBBIN RIDGE RD
KNOXVILLE TN
37923-6710
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5565
  • Fax:
Mailing address:
  • Phone: 865-228-4136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME143895
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number312760
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number312760
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: