Provider Demographics
NPI:1144230087
Name:MARTIN, HAROLD L (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:L
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 1:108 ENDO LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-4566
Mailing Address - Country:US
Mailing Address - Phone:910-205-8909
Mailing Address - Fax:910-205-8952
Practice Address - Street 1:108 ENDO LN
Practice Address - Street 2:SUITE 1
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-4566
Practice Address - Country:US
Practice Address - Phone:910-205-8909
Practice Address - Fax:910-205-8952
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0033154208600000X
NC2006-01482208600000X
GA047924208600000X
AL13989208600000X
MT10901208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC70853Medicare UPIN