Provider Demographics
NPI:1235179540
Name:CHAMBERS, MARTIN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:LEE
Last Name:CHAMBERS
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 1:200 E MAHONING STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767
Mailing Address - Country:US
Mailing Address - Phone:814-938-0422
Mailing Address - Fax:814-938-0424
Practice Address - Street 1:200 E MAHONING ST
Practice Address - Street 2:STE 1
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2045
Practice Address - Country:US
Practice Address - Phone:814-938-0422
Practice Address - Fax:814-938-0424
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042709L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA306683OtherHEALTH ASSURANCE
PAP000959OtherGATEWAY INDIVIDUAL
PA010165200OtherBLACK LUNG
PA001259184 0006Medicaid
PA217749OtherUPMC
PA001259184 0006Medicaid