Provider Demographics
NPI:1164497582
Name:MARTIN, DENNIS EMERSON (DPM)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:EMERSON
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9279 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9141
Mailing Address - Country:US
Mailing Address - Phone:843-553-2223
Mailing Address - Fax:843-553-2275
Practice Address - Street 1:9279 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE D
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9141
Practice Address - Country:US
Practice Address - Phone:843-553-2223
Practice Address - Fax:843-553-2275
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC114213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD1144Medicaid
SCPD1144Medicaid
SCU128495062Medicare ID - Type UnspecifiedSC MEDICARE