Provider Demographics
NPI:1568438711
Name:ROLLI, MARTHA LEIGH (MD)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:LEIGH
Last Name:ROLLI
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 1:6007 WINNEQUAH ROAD
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716
Mailing Address - Country:US
Mailing Address - Phone:608-235-5368
Mailing Address - Fax:
Practice Address - Street 1:6007 WINNEQUAH ROAD
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716
Practice Address - Country:US
Practice Address - Phone:608-265-8130
Practice Address - Fax:608-263-7263
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI345592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31971300Medicaid
071115875Medicare ID - Type Unspecified
F65631Medicare UPIN