Provider Demographics
NPI:1225154867
Name:MARTIN, DERRICK A (DPT)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 GREENWAY CENTER DR
Mailing Address - Street 2:SUITE 800
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3514
Mailing Address - Country:US
Mailing Address - Phone:301-220-2316
Mailing Address - Fax:301-220-2319
Practice Address - Street 1:7501 GREENWAY CENTER DR
Practice Address - Street 2:SUITE 800
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3514
Practice Address - Country:US
Practice Address - Phone:301-220-2316
Practice Address - Fax:301-220-2319
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2009-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18131225100000X
DC2656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD961002200Medicaid
DC0001OtherCAREFIRST BCBS
MD01302934OtherAMERIGROUP
MD545048096OtherCAREFIRST BCBS
DC163124ZEPUMedicare PIN