Provider Demographics
NPI:1225241573
Name:MARTYN, NICK (MD)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:
Last Name:MARTYN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 JOHN PAUL JONES CIR
Mailing Address - Street 2:FAMILY MEDICINE CLINIC.NAVAL MEDICAL CENTER, PORTSMOUTH
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708-2111
Mailing Address - Country:US
Mailing Address - Phone:757-953-0515
Mailing Address - Fax:757-953-1760
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:FAMILY MEDICINE CLINIC.NAVAL MEDICAL CENTER, PORTSMOUTH
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-0515
Practice Address - Fax:757-953-1760
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57-012557390200000X
VA0101246207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine