Provider Demographics
NPI:1174726681
Name:MARTIN, VICTORIA B (MD)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:B
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DOROTHY
Other - Middle Name:VICTORIA
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1219 ABRAMS RD STE 240
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5583
Mailing Address - Country:US
Mailing Address - Phone:972-994-0540
Mailing Address - Fax:972-994-0978
Practice Address - Street 1:1219 ABRAMS RD STE 240
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5583
Practice Address - Country:US
Practice Address - Phone:972-994-0540
Practice Address - Fax:972-994-0978
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH25652084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE46778Medicare UPIN