Provider Demographics
NPI:1568653509
Name:MARTIN, LUDMILA KATHERINE (MD)
Entity type:Individual
Prefix:
First Name:LUDMILA
Middle Name:KATHERINE
Last Name:MARTIN
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 1:2920 S MERIDIAN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1428
Mailing Address - Country:US
Mailing Address - Phone:253-841-4296
Mailing Address - Fax:253-841-2435
Practice Address - Street 1:1624 S I ST
Practice Address - Street 2:SUITE 305
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5016
Practice Address - Country:US
Practice Address - Phone:253-428-8700
Practice Address - Fax:253-383-3376
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60384465207R00000X
OH35.094489207R00000X
WA60384465207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01363075OtherRAILROAD MEDICARE
WA2030126Medicaid
WAG8921430Medicare UPIN