Provider Demographics
NPI:1134113467
Name:MARTIN, LEE BALDWIN JR (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:BALDWIN
Last Name:MARTIN
Suffix:JR
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 1:437 N PARK DR
Mailing Address - Street 2:STE 1
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-2315
Mailing Address - Country:US
Mailing Address - Phone:703-527-1339
Mailing Address - Fax:703-527-9733
Practice Address - Street 1:437 N PARK DR
Practice Address - Street 2:STE 1
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-2315
Practice Address - Country:US
Practice Address - Phone:703-527-1339
Practice Address - Fax:703-527-9733
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101020870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B6630001OtherCAREFIRST BCBS
B6630001OtherCAREFIRST BCBS
163377Medicare ID - Type Unspecified