Provider Demographics
NPI:1629879614
Name:MARTIN, ELIZABETH LORENE (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LORENE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LORENE
Other - Last Name:BELUSAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10720 LAKE MAY RD
Mailing Address - Street 2:
Mailing Address - City:HAWKS
Mailing Address - State:MI
Mailing Address - Zip Code:49743-9789
Mailing Address - Country:US
Mailing Address - Phone:989-351-7740
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program