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General NPI Number Information
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NPI Number | 1033352604
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Entity Type | Individual
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Provider Name | ANGELA SUE BEALE MARTIN MD
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Gender | Female
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Dates
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Enumeration Date | 04/13/2009
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 1 MEDICAL VILLAGE DR
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City | EDGEWOOD
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State | KY
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Zip | 41017-3403
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Country | US
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Telephone | 859-301-2440
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Fax | 859-301-2493
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Provider Business Mailing Address
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Address Line | 2001 W 86TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-1902
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Country | US
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Telephone | 317-338-2281
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Fax | 317-338-6359
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 11015063A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 53482
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License Number State | KY
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