Provider Demographics
NPI:1093927899
Name:MARTIN S. WASSERMAN M.D. INC.
Entity Type:Organization
Organization Name:MARTIN S. WASSERMAN M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WASSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-454-8870
Mailing Address - Street 1:510 E CHANNEL RD.
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA.
Mailing Address - State:CA
Mailing Address - Zip Code:90402
Mailing Address - Country:US
Mailing Address - Phone:310-454-8870
Mailing Address - Fax:
Practice Address - Street 1:510 E CHANNEL RD.
Practice Address - Street 2:
Practice Address - City:SANTA MONICA.
Practice Address - State:CA
Practice Address - Zip Code:90402
Practice Address - Country:US
Practice Address - Phone:310-454-8870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty