MEDICARE: MARTHA ANNE DEBERRY KING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	LL39874	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205287786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA ANNE DEBERRY KING

Provider Business Mailing Address
First Line	:	1514 GARDENIA RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-5212
Country	:	US
Telephone Number	:	843-687-9967
Fax Number	:

Provider Business Practice Location Address
First Line	:	1514 GARDENIA RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-5212
Country	:	US
Telephone Number	:	843-687-9967
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	06/27/2016

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