Provider Demographics
NPI:1154500494
Name:DAVID L. MARTIN, M.D., INC
Entity Type:Organization
Organization Name:DAVID L. MARTIN, M.D., INC
Other - Org Name:DAVID L. MARTIN M.D., INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-649-0161
Mailing Address - Street 1:2101 JACKSON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4387
Mailing Address - Country:US
Mailing Address - Phone:765-649-0161
Mailing Address - Fax:765-644-4995
Practice Address - Street 1:2101 JACKSON ST STE 201
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4387
Practice Address - Country:US
Practice Address - Phone:765-649-0161
Practice Address - Fax:765-644-4995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01020486207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN503460Medicare PIN