Provider Demographics
NPI:1386618007
Name:YEARSLEY, MARTHA F (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:F
Last Name:YEARSLEY
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 1:1005 DORBETT ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2619
Mailing Address - Country:US
Mailing Address - Phone:812-482-5700
Mailing Address - Fax:812-481-1045
Practice Address - Street 1:1005 DORBETT ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2619
Practice Address - Country:US
Practice Address - Phone:812-482-5700
Practice Address - Fax:812-481-1045
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042841207R00000X, 208000000X
IL036-084691207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN990007893OtherMEDICARE RAILROAD
IN100414290BMedicaid
IN1B0000001823OtherANTHEM BCBS
IN990007893OtherMEDICARE RAILROAD
F46493Medicare UPIN