Provider Demographics
NPI:1326197799
Name:MARTIN, THOMAS ROGER JR (MS ATC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROGER
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9510 PERRY HALL BLVD
Mailing Address - Street 2:APT 104
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8322 BELLONA AVE
Practice Address - Street 2:STE 303
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2012
Practice Address - Country:US
Practice Address - Phone:410-374-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer