Provider Demographics
NPI:1063524460
Name:MARTIN-KO, ANNE CATHERINE (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:CATHERINE
Last Name:MARTIN-KO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 HOSPITAL DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4533
Mailing Address - Country:US
Mailing Address - Phone:707-463-8000
Mailing Address - Fax:707-462-1111
Practice Address - Street 1:260 HOSPITAL DR
Practice Address - Street 2:SUITE 204
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4533
Practice Address - Country:US
Practice Address - Phone:707-463-3470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048496L2080A0000X
CAC549812080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0366976OtherCIGNA
PA42469OtherAETNA
PA575394OtherHIGHMARK
PA000000853AOtherUPMC
PA90923Medicaid
PA0012644510003OUMedicaid
PA0014521480001Medicaid
PA0014521480001Medicaid