Healthcare Provider Details

I. General information

NPI: 1982724019
Provider Name (Legal Business Name): LOURDES ECHENIQUE MARTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 GODWIN BLVD STE 360
SUFFOLK VA
23434-8153
US

IV. Provider business mailing address

2790 GODWIN BLVD STE 360
SUFFOLK VA
23434-8153
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-4821
  • Fax:
Mailing address:
  • Phone: 757-934-4821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101051494
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101051494
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: