Provider Demographics
NPI:1124125422
Name:WOLEBEN, MARTYN DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARTYN
Middle Name:DEAN
Last Name:WOLEBEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2337 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-8933
Mailing Address - Country:US
Mailing Address - Phone:910-862-1992
Mailing Address - Fax:910-862-6674
Practice Address - Street 1:300 E MCKAY ST.
Practice Address - Street 2:STE F
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337
Practice Address - Country:US
Practice Address - Phone:910-862-6672
Practice Address - Fax:910-862-6674
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97-00428207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891039CMedicaid
NC2237208AMedicare ID - Type Unspecified
NC891039CMedicaid