Provider Demographics
NPI:1225051337
Name:MARTIN, GEORGE L (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
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 1:100 E LANCASTER AVE
Mailing Address - Street 2:LANKENAU MEDICAL BUILDING SUITE 237 WEST
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3451
Mailing Address - Country:US
Mailing Address - Phone:610-649-9300
Mailing Address - Fax:610-896-4617
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:LANKENAU MEDICAL BUILDING SUITE 237 WEST
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3451
Practice Address - Country:US
Practice Address - Phone:610-649-9300
Practice Address - Fax:610-896-4617
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019289E207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C30230Medicare UPIN
PA105748JA0Medicare ID - Type Unspecified