Provider Demographics
NPI:1134700198
Name:MARTIN, DAVID MICHAEL
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 MAIN ST # 257
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-2416
Mailing Address - Country:US
Mailing Address - Phone:215-527-9528
Mailing Address - Fax:
Practice Address - Street 1:292 MAIN ST # 257
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-2416
Practice Address - Country:US
Practice Address - Phone:215-527-9528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
No171W00000XOther Service ProvidersContractor
No374700000XNursing Service Related ProvidersTechnician
No376J00000XNursing Service Related ProvidersHomemaker