Provider Demographics
NPI:1336120112
Name:MARTIN, ANDRES S (MD)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:S
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 1:230 S FRONTAGE RD
Mailing Address - Street 2:CHILD STUDY CENTER - WWW-1
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1124
Mailing Address - Country:US
Mailing Address - Phone:203-785-2513
Mailing Address - Fax:203-785-4914
Practice Address - Street 1:230 S FRONTAGE RD
Practice Address - Street 2:CHILD STUDY CENTER - WWW-1
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1124
Practice Address - Country:US
Practice Address - Phone:203-785-2513
Practice Address - Fax:203-785-4914
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0354072084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004039269Medicaid
CT004039269Medicaid
CT260002834Medicare ID - Type Unspecified