MEDICARE: MARTHA LYNNE DECKER MD

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	207V00000X	Obstetrics & Gynecology Physician	33981	NC

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
2	67442	OTHER		BCBS

General Provider Information

NPI Number	:	1558444703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA LYNNE DECKER MD

Provider Business Mailing Address
First Line	:	PO BOX 344
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27102-0344
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 SHEPHERD ST
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1633
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	01/11/2012

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