Individual
EBONI T. MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2855 CRAIN HWY, WALDORF, MD 20601
(240) 427-1926
Mailing address
5000 COX RD, GLEN ALLEN, VA 23060-9263
(804) 968-5700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0085927
MD
207Q00000X
Family Medicine Physician
MD35858
AL
Other
Enumeration date
05/10/2013
Last updated
08/29/2018
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