Provider Demographics
NPI:1043234198
Name:MARTIN, ELIZABETH R (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 HIGHLAND AVE SE
Practice Address - Street 2:STE 200
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24013-2201
Practice Address - Country:US
Practice Address - Phone:540-982-8881
Practice Address - Fax:540-982-0501
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101102666207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6216668Medicaid
VA6216668Medicaid