Healthcare Provider Details

I. General information

NPI: 1609230176
Provider Name (Legal Business Name): ANDREW MARTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 GAINSBOROUGH SQ STE 400
CHESAPEAKE VA
23320-1714
US

IV. Provider business mailing address

WALTER REED NATIONAL MILITARY CTR 8901 WISCONSIN AVENUE
BETHESDA MD
20889-5600
US

V. Phone/Fax

Practice location:
  • Phone: 757-842-4499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101271002
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: