Provider Demographics
NPI:1073611901
Name:MAGRAM, MARTIN Y (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:Y
Last Name:MAGRAM
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 1:3611 GARDENVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1511
Mailing Address - Country:US
Mailing Address - Phone:301-733-1031
Mailing Address - Fax:
Practice Address - Street 1:3611 GARDENVIEW RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-1511
Practice Address - Country:US
Practice Address - Phone:301-733-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD155402085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD789581000Medicaid
P00419001Medicare PIN
MDH547Q977Medicare PIN
MDB67110Medicare UPIN
P00344211Medicare PIN
MDKN77O634Medicare PIN