Provider Demographics
NPI:1144264730
Name:DAVID, MARTHA ANN (MD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
Last Name:DAVID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6668 FOURTH SECTION RD
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-2448
Mailing Address - Country:US
Mailing Address - Phone:585-368-6870
Mailing Address - Fax:585-368-6871
Practice Address - Street 1:6668 FOURTH SECTION RD
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-2448
Practice Address - Country:US
Practice Address - Phone:585-368-6870
Practice Address - Fax:585-368-6871
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01684995Medicaid
NYJ400311506-GRPBA0017Medicare PIN
NYJ400311440-GRP70008AMedicare PIN
NY2593622OtherAETNA HMO
NY80147189OtherRR MEDICARE
NY7857197OtherAETNA PPO/POS
NY005260301OtherHEALTH NOW BCBSWNY
NY783476OtherMVP SELECT CARE
NY01684995Medicaid
NYE99905Medicare UPIN
NY010178837OtherEXCELLUS
NY178837-CFPOtherWORKERS' COMP
NY00378712Medicaid