EBONI T. MARTIN (NPI# 1538505094) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538505094 |
| Entity Type | Individual |
| Full Name | EBONI T. MARTIN |
| Credential | M.D. |
| Practice Address |
2855 Crain Hwy Waldorf MD 20601 |
| Mailing Address |
5000 Cox Rd Glen Allen VA 23060-9263 |
| Practice Telephone | 2404271926 |
| Mailing Telephone | 8049685700 |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2018-08-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | D0085927 | MD | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | MD35858 | AL | Allopathic & Osteopathic Physicians |
| Street Address |
2855 CRAIN HWY |
| City | WALDORF |
| State | MD |
| Zip Code | 20601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831177419 | Michael P. Dalgetty | Family Medicine | 2855 Crain Hwy, Waldorf, MD 20601-2840 | 2006-01-04 |
| 1194104729 | Lachrisa S. Jennings | Family Medicine | 2855 Crain Hwy, Waldorf, MD 20601-2840 | 2015-05-28 |
| 1578957932 | Ganiyat Olasumbo Anike Oladapo | Family Medicine | 2855 Crain Hwy, Waldorf, MD 20601-2840 | 2015-03-24 |
| 1649672346 | Monisha Ann Paris | Physician Assistant | 2855 Crain Hwy, Waldorf, MD 20601-2840 | 2014-09-24 |
| 1942610787 | Cassandra Cherie Cannon | Physician Assistant | 2855 Crain Hwy, Waldorf, MD 20601-2840 | 2014-05-01 |
| 1750716387 | Kathryn Hardin Edwards | Physician Assistant | 2855 Crain Hwy, Waldorf, MD 20601-2840 | 2013-09-13 |
| 1063722577 | Ili Wathen | Physician Assistant | 2855 Crain Hwy, Waldorf, MD 20601-2840 | 2010-10-18 |
| 1861709099 | Aaron P Henry | Physician Assistant | 2855 Crain Hwy, Waldorf, MD 20601-2840 | 2010-09-09 |
| 1447578802 | Ijeamaka Karyn Ofodile | Family Medicine | 2855 Crain Hwy, Waldorf, MD 20601-2807 | 2010-05-11 |
| 1770726127 | Anatoli Andreevich Bute Gusaim | Family Medicine | 2855 Crain Hwy, Waldorf, MD 20601-2807 | 2009-04-15 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154960128 | Sarian Beverly Wilson | Nurse Practitioner | 2203 Kayhill Dr, Waldorf, MD 20601 | 2019-12-23 |
| 1447778055 | Macy Alexandra Forman | Pharmacist | 3061 Tecnology Place, Waldorf, MD 20601 | 2017-09-04 |
| 1922523919 | Gregoire Mcclain | Counselor | Pathways Inc 2670 Crain Hwy, Suite 409, Waldorf, MD 20601 | 2017-08-10 |
| 1477091866 | Lutisse Cooper | Home Health Aide | 2520 Breakwater Court, Waldorf, MD 20601 | 2017-02-06 |
| 1609321637 | Kierra Jordan | Counselor | 2255 Crain Hwy Ste 102, Waldorf, MD 20601 | 2016-08-19 |
| 1215286828 | Linda Kline-lau | Counselor | 2255 Crain Highway, Waldorf, MD 20601 | 2012-08-29 |
| 1205124609 | Marian E. Kirk | Physical Therapist | 2960 Technology Place, Suite 110, Waldorf, MD 20601 | 2011-07-19 |
| 1932345238 | Patient First Maryland Medical Group | Non-Pharmacy Dispensing Site | 2855 Crain Highway, Waldorf, MD 20601 | 2008-12-17 |
| 1720150741 | Marianna Jeanne Patente | Counselor | 2670 Crain Highway, Suite #401, Waldorf, MD 20601 | 2006-11-14 |
| 1407940968 | Harold J. Pincus | Dentist | 2955 Crain Hwy., Waldorf, MD 20601 | 2006-10-02 |
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| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801452362 | Outreach Recovery II, LLC | Family Medicine | 3649 Leonardtown Rd, Waldorf, MD 20601-3626 | 2019-05-10 |
| 1154764744 | Ashley Dunn-kerr | Family Medicine | 3225 Crain Hwy, Waldorf, MD 20603-4848 | 2013-04-12 |
| 1952564973 | Majd M Arnaout | Family Medicine | 177 Saint Patricks Drive, Waldorf, MD 20603-5533 | 2008-07-09 |
| 1841452687 | Lulita Lucero-ugalino | Family Medicine | 6b Industrial Park Drive, Unit 8, Waldorf, MD 20735-2073 | 2008-07-01 |
| 1780629683 | Medstar Southern Maryland Physicians, LLC | Family Medicine | 10 St Patricks Drive, Suite 203, Waldorf, MD 20603-4527 | 2006-06-17 |
| 1194765834 | Dainty J Jackson | Family Medicine | 11315 Pembrooke Sq Ste 112, Waldorf, MD 20603-4806 | 2006-06-08 |
| 1831177419 | Michael P. Dalgetty | Family Medicine | 2855 Crain Hwy, Waldorf, MD 20601-2840 | 2006-01-04 |
| 1679579361 | Richard A Farson | Family Medicine | 10 Saint Patricks Dr, Ste 203, Waldorf, MD 20603-4527 | 2005-06-27 |
| 1508341009 | Prime Medical Health Center, Inc | Family Medicine | 6b Industrial Park Drive, Unit 8, Waldorf, MD 20735-2073 | 2018-10-01 |
| 1194104729 | Lachrisa S. Jennings | Family Medicine | 2855 Crain Hwy, Waldorf, MD 20601-2840 | 2015-05-28 |
| Find all providers in WALDORF | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.