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General NPI Number Information
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NPI Number | 1982896296
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Entity Type | Individual
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Provider Name | MARY LOUISE MARTIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 3223 8TH ST
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City | METAIRIE
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State | LA
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Zip | 70002-1623
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Country | US
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Telephone | 504-833-7770
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 276
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City | ZACHARY
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State | LA
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Zip | 70791-0276
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Country | US
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Telephone | 626-394-3198
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Fax | 225-654-8750
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A99897
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD.203324
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License Number State | LA
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