Provider Demographics
NPI:1346286366
Name:MARTIN, CHRISTIAN E (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:E
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 1:520 N DEKALB ST STE B
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4191
Mailing Address - Country:US
Mailing Address - Phone:704-484-8001
Mailing Address - Fax:704-484-2485
Practice Address - Street 1:520 N DEKALB ST STE B
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4191
Practice Address - Country:US
Practice Address - Phone:704-484-8001
Practice Address - Fax:704-484-2485
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126G9Medicaid
NC1282MOtherBCBS OF NC
2292135Medicare ID - Type Unspecified