Provider Demographics
NPI:1003842865
Name:MARTIN, THOMAS V (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:V
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 ORCHARD ST
Mailing Address - Street 2:SUITE 164
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4417
Mailing Address - Country:US
Mailing Address - Phone:203-789-2222
Mailing Address - Fax:203-624-3697
Practice Address - Street 1:330 ORCHARD ST
Practice Address - Street 2:SUITE 164
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4417
Practice Address - Country:US
Practice Address - Phone:203-789-2222
Practice Address - Fax:203-624-3697
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034246208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT340000242Medicare ID - Type UnspecifiedMEDICARE NUMBER
CTF95051Medicare UPIN