Provider Demographics
NPI:1144308453
Name:MARTIN-CONCEPCION, NANCY M (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:MARTIN-CONCEPCION
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 1:8836 N 23RD AVE STE B1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4175
Mailing Address - Country:US
Mailing Address - Phone:602-944-9810
Mailing Address - Fax:602-944-1547
Practice Address - Street 1:8836 N 23RD AVE STE B1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4175
Practice Address - Country:US
Practice Address - Phone:602-944-9810
Practice Address - Fax:602-944-1547
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ333052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ899247Medicaid
AZ122359Medicare UPIN
AZ103347Medicare ID - Type Unspecified