Provider Demographics
NPI:1326009028
Name:MARTIN, WILLIAM IV (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:MARTIN
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6500 HARBOUR VIEW CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2157
Mailing Address - Country:US
Mailing Address - Phone:804-639-4050
Mailing Address - Fax:804-639-4049
Practice Address - Street 1:6500 HARBOUR VIEW CT
Practice Address - Street 2:SUITE 102
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2157
Practice Address - Country:US
Practice Address - Phone:804-639-4050
Practice Address - Fax:804-639-4049
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2007-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101038348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine