Provider Demographics
NPI:1245211416
Name:MARTIN, MAURICE JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:JOSEPH
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 1:245 E 21ST ST APT 14A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6412
Mailing Address - Country:US
Mailing Address - Phone:617-838-5587
Mailing Address - Fax:
Practice Address - Street 1:1824 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3832
Practice Address - Country:US
Practice Address - Phone:212-423-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA041834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080046335OtherRR MEDICARE
MA2073382Medicaid
080046335OtherRR MEDICARE
7598OtherHARVARD PILGRIM HEALTHCAR
MA2073382Medicaid
MAB39178OtherBCBS
B73113Medicare UPIN
080046335OtherRR MEDICARE
MASX3905Medicare PIN