Provider Demographics
NPI:1366698946
Name:MARTIN, TERESA A (AUD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:A
Other - Last Name:NEWGENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 SE CARY PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5678
Mailing Address - Country:US
Mailing Address - Phone:919-784-7400
Mailing Address - Fax:
Practice Address - Street 1:790 SE CARY PKWY STE 110
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5678
Practice Address - Country:US
Practice Address - Phone:919-784-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001479231H00000X
DCHD0300079231H00000X
NC13670231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist