Provider Demographics
NPI:1306030879
Name:MARTIN, JOSEPH B (MD, PHD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:B
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 LONGWOOD AVE
Mailing Address - Street 2:HARVARD MEDICAL SCHOOL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5701
Mailing Address - Country:US
Mailing Address - Phone:617-432-7197
Mailing Address - Fax:
Practice Address - Street 1:220 LONGWOOD AVE
Practice Address - Street 2:HARVARD MEDICAL SCHOOL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5701
Practice Address - Country:US
Practice Address - Phone:617-432-7197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA426252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology