Provider Demographics
NPI:1134122955
Name:MARTIN, CHRISTOPHER G (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:G
Last Name:MARTIN
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 1:85 BRYANT WOODS S
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-3604
Mailing Address - Country:US
Mailing Address - Phone:716-689-3333
Mailing Address - Fax:716-689-9866
Practice Address - Street 1:85 BRYANT WOODS S
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-3604
Practice Address - Country:US
Practice Address - Phone:716-689-3333
Practice Address - Fax:716-689-9866
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1919712084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020243301OtherUNIVERA
NY01659241Medicaid
NY1508057OtherINDEPENDENT HEALTH
NY10458757OtherCAQH
NY157862OtherVALUE OPTIONS
NY000524147005OtherHEALTH INTEGRATED
NY10458757OtherCAQH
NY1508057OtherINDEPENDENT HEALTH