Provider Demographics
NPI:1356602080
Name:MAXTED, MARTA (MD)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:MAXTED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:
Other - Last Name:MARNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:800 SL YOUNG BLVD
Mailing Address - Street 2:ANDREWS ACADEMIC TOWER 2475
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5036
Mailing Address - Country:US
Mailing Address - Phone:405-271-8469
Mailing Address - Fax:
Practice Address - Street 1:800 SL YOUNG BLVD
Practice Address - Street 2:AAT 2475
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-8469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29232207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology