Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 0101265405 | VA |
N | 207RG0300X | Geriatric Medicine | 2007006297 | MO |
NPI | 1134347347 |
---|---|
Provider Name | Dr. Carol Reyburn Martin |
First Address | Great Falls, VA 22066-1847 |
Second Address | Great Falls, VA 22066-1847 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 02/11/2021 |