Provider Demographics
NPI:1184198343
Name:MARTIN, SAMUEL
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
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 1:18040 VIA BELLAMARE LN
Mailing Address - Street 2:
Mailing Address - City:MIROMAR LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33913-7606
Mailing Address - Country:US
Mailing Address - Phone:646-421-8499
Mailing Address - Fax:
Practice Address - Street 1:18040 VIA BELLAMARE LN
Practice Address - Street 2:
Practice Address - City:MIROMAR LAKES
Practice Address - State:FL
Practice Address - Zip Code:33913-7606
Practice Address - Country:US
Practice Address - Phone:646-421-8499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS