Provider Demographics
NPI:1942838933
Name:MARTIN, AUDREY ELIZABETH (DO)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:ELIZABETH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E BOYD AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-2818
Mailing Address - Country:US
Mailing Address - Phone:317-477-6500
Mailing Address - Fax:
Practice Address - Street 1:300 E BOYD AVE STE 208
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-2818
Practice Address - Country:US
Practice Address - Phone:317-477-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02007798A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology