Provider Demographics
NPI:1154329993
Name:PATERSON, MARTHA S (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:S
Last Name:PATERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0018
Mailing Address - Fax:225-765-9468
Practice Address - Street 1:5428 ODONOVAN DR STE D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4387
Practice Address - Country:US
Practice Address - Phone:225-214-0620
Practice Address - Fax:225-214-0621
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH08769Medicare UPIN
LA5H042Medicare PIN
LA5H042Medicare PIN