Provider Demographics
NPI:1689827990
Name:MOE, MARTHA C (MD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:C
Last Name:MOE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:CHRISTINE
Other - Last Name:MOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12303 NE 130TH LN STE 450
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3032
Mailing Address - Country:US
Mailing Address - Phone:425-899-5000
Mailing Address - Fax:425-899-5006
Practice Address - Street 1:20 POWEL AVENUE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840
Practice Address - Country:US
Practice Address - Phone:401-848-5556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD18398207V00000X
WAMD00048423207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology