Provider Demographics
NPI:1083603401
Name:ALDRICH, MARTIN C (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:C
Last Name:ALDRICH
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 1:6310 HEALTH PARK WAY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5177
Mailing Address - Country:US
Mailing Address - Phone:941-359-8900
Mailing Address - Fax:941-359-8991
Practice Address - Street 1:6310 HEALTH PARK WAY
Practice Address - Street 2:SUITE 330
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5177
Practice Address - Country:US
Practice Address - Phone:941-359-8900
Practice Address - Fax:941-359-8991
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85369207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264778800Medicaid
16003OtherBCBS
10703493OtherCAQH
16003OtherBCBS
FL16003WMedicare PIN