Healthcare Provider Details

I. General information

NPI: 1194768788
Provider Name (Legal Business Name): ANDREA R COBB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA R MARTIN MD

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HIGHLAND AVE SE STE 303
ROANOKE VA
24013-2253
US

IV. Provider business mailing address

213 S JEFFERSON ST
ROANOKE VA
24011-1705
US

V. Phone/Fax

Practice location:
  • Phone: 540-985-9715
  • Fax: 540-985-8487
Mailing address:
  • Phone: 540-224-5516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101239777
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2013039509
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: