Provider Demographics
NPI:1669534871
Name:MARTENS, WERNER (MD)
Entity type:Individual
Prefix:
First Name:WERNER
Middle Name:
Last Name:MARTENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 GRAYDON AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1208
Mailing Address - Country:US
Mailing Address - Phone:757-622-1661
Mailing Address - Fax:757-627-0704
Practice Address - Street 1:902 GRAYDON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1208
Practice Address - Country:US
Practice Address - Phone:757-622-1661
Practice Address - Fax:757-627-0704
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101022116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA12073OtherOPTIMA
222838OtherMDIPA
VA016367OtherHEALTHKEEPERS
VA016367OtherANTHEM
VA6040985Medicaid
NC8902073Medicaid
VA12073OtherSENTARA
222838OtherALLIANCE
222838OtherGEHA
222838OtherMAMSI
VA12073OtherSENTARA
VA1119551154Medicare PIN