Provider Demographics
NPI:1114921186
Name:MARTIN, ROBERT W (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4154
Mailing Address - Country:US
Mailing Address - Phone:717-397-2738
Mailing Address - Fax:717-397-7634
Practice Address - Street 1:2301 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4154
Practice Address - Country:US
Practice Address - Phone:717-397-2738
Practice Address - Fax:717-397-7634
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA008117E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0527871001OtherCIGNA PROVIDER NUMBER
PA859628OtherBLUE SHIELD PROVIDER #
PA30813OtherGEISINGER HEALTHPLAN PROV
PA01031901OtherCAPITAL BLUE CROSS PROV#
PA695233OtherAETNA US HEALTHCARE PROVI
PA0007399160001Medicaid
PA695233OtherAETNA US HEALTHCARE PROVI