Healthcare Provider Details

I. General information

NPI: 1760450514
Provider Name (Legal Business Name): MARTHA ANN HURLEY D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 FALCON DR
FREDERICKSBURG VA
22408-1930
US

IV. Provider business mailing address

PO BOX 8389
FREDERICKSBURG VA
22404-8389
US

V. Phone/Fax

Practice location:
  • Phone: 540-371-2724
  • Fax: 540-371-5072
Mailing address:
  • Phone: 540-371-2724
  • Fax: 540-371-5072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0103000972
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: